Journal articles on the topic 'Triage (Medicine) Decision making'
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Mirhaghi, A., G. R. Mohammadi, and M. Asghari. "(A260) Triage Decision-Making in Intoxication." Prehospital and Disaster Medicine 26, S1 (May 2011): s71—s72. http://dx.doi.org/10.1017/s1049023x11002445.
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Background and AimsDecision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.MethodsCritical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.ResultsGeneral physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.DiscussionResources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
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Cioffi, J. "Triage decision making: Educational strategies." Accident and Emergency Nursing 7, no. 2 (April 1999): 106–11. http://dx.doi.org/10.1016/s0965-2302(99)80031-9.
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Mirhaghi, A., M. Sajjadi, and A. Golafshani. "(A279) Evidence-Based Decision-Making in Triage." Prehospital and Disaster Medicine 26, S1 (May 2011): s77. http://dx.doi.org/10.1017/s1049023x11002639.
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Background and AimsDecision-making is the major component in triaging emergency department patients. Influencing factors on decision-making have been identified but it`s not clear how much of the decision is based upon scientific criteria. The objective of this study was to determine frequency of using reliable and valid guidelines by nurses in emergency departments.MethodsIt was a descriptive survey study. The questionnaire was composed of demographic data, evidence-based triage questions (15) and triage decision-making questions (10). The questionnaire reliability was 0.87 using the test-retest method. Content validity was considered based upon Canadian Triage and Acuity Scale.Results70 nurses from 10 emergency departments participated. 40 % of nurses` responses to evidence-based questions was correct. The percentage of inter-rater agreement between nurses was moderate (0.56) related to decision-making questions. No valid and reliable guideline was utilized in emergency departments.ConclusionNurses` decision-making was poorly based on evidence-based criteria. Low level of nurses` knowledge about triage may be derived from lack of official and specialized triage training courses. Academic triage courses establishment and development of national triage scale are recommended.
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Levy, Mitchell M. "Triage decision making for the elderly." Critical Care Medicine 40, no. 1 (January 2012): 323–24. http://dx.doi.org/10.1097/ccm.0b013e31823b96fe.
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Kilner, Tim, and F. John Hall. "Triage Decisions of United Kingdom Police Firearms Officers Using a Multiple-Casualty Scenario Paper Exercise." Prehospital and Disaster Medicine 20, no. 1 (February 2005): 40–46. http://dx.doi.org/10.1017/s1049023x00002132.
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AbstractIntroduction:British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.Methods:Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.Results:The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.Conclusion:It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.
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Cioffi, J. "Decision making by emergency nurses in triage assessments." Accident and Emergency Nursing 6, no. 4 (October 1998): 184–91. http://dx.doi.org/10.1016/s0965-2302(98)90077-7.
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Whelan, Lori, William Justice, Jeffrey M. Goodloe, Jeff D. Dixon, and Stephen H. Thomas. "Trauma Ultrasound in Civilian Tactical Medicine." Emergency Medicine International 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/781570.
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The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years’ literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.
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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO70: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 20, S1 (May 2018): S31—S32. http://dx.doi.org/10.1017/cem.2018.132.
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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, ED funding and workload models. The Electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes the application of national triage guidelines (CTAS) across Ontario. The objective of this study was to evaluate the implementation of eCTAS in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1200 (738 pre-eCTAS, 462 post-implementation) individual patient CTAS assessments were audited over 33 (21 pre-eCTAS, 11 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients pre-eCTAS, compared to 429 (93.0%) patients triaged with eCTAS. Using the auditors CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.1% vs. 3.2%; 8.9, 95% CI: 5.7, 11.7) and under-triaged (12.9% vs. 3.9%; 9.0, 95% CI: 5.9, 12.0). Interrater agreement was higher with eCTAS (unweighted kappa 0.90 vs 0.63; quadratic-weighted kappa 0.79 vs. 0.94). Research assistants captured triage time for 4403 patients pre-eCTAS and 1849 post implementation of eCTAS. Median triage time was 304 seconds pre-eCTAS and 329 seconds with eCTAS ( 25 seconds, 95% CI: 18, 32 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
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Miladinia, Mojtaba, Farhad Abolnezhadian, Joachim G. Voss, Kourosh Zarea, Naser Hatamzadeh, and Mandana Ghanavati. "Final triage methods to decide on home-isolation versus hospitalization in COVID-19 pandemic: a challenge for clinicians." Journal of Emergency Practice and Trauma 8, no. 2 (September 23, 2020): 90–94. http://dx.doi.org/10.34172/jept.2020.37.
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Objective: Final patient triage determines which patients can be home-isolated and which patients require hospitalization on the basis to predict the patient’s prognosis most accurately. Final triage is an important link in the clinical management chain of the coronavirus disease 2019 (COVID-19) pandemic, and a comprehensive review of various patient triage methods is very important to guide decision making and triage efficiency. Decision by clinicians about hospitalization or home-discharge is one of the main challenges in places with limited hospital facilities compared to the high volume of COVID-19 patients. This review was designed to guide clinicians on how to address this challenge. Methods: In this mini review we searched scientific databases to obtain the final triage methods of COVID-19 patients and the important criteria in each method. In order to conducted searches a period from December 2019 to July 2020 was considered. All searches were done in electronic databases and search engines. Results: Findings revealed four current methods for final triage (decision-making regarding home-isolation or hospitalization of COVID-19 patients). These methods included 1) demographic and background information, 2) clinical information, 3) laboratory indicators and 4) initial chest CT-scan. Each of the aforementioned methods encompassed significant criteria according to which decisions on the patient’s prognosis and final triage were made. Finally, by evaluating each final triage method, we found that each method had some limitations. Conclusion: An effective and quick final triage requires simultaneous complementary use of all four methods to compensate for each other’s weaknesses and add to each other’s strengths. It is therefore suggested to assure that clinicians are trained in all four COVID-19 patient’s triage methods and their useful criteria in order to achieve evidence-based performance for better triage (decision between home-isolation versus hospitalization).
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Mulla, MD, MSc, Ali, Blair L. Bigham, MD, MSc, DTMH, Andrea Frolic, MA, PhD, and Michael D. Christian, MD, MSc, FRCPC. "Canadian emergency medicine and critical care physician perspectives on pandemic triage in COVID-19." Journal of Emergency Management 18, no. 7 (December 8, 2020): 31–35. http://dx.doi.org/10.5055/jem.2020.0484.
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Introduction: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic.Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support.Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.
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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO81: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 21, S1 (May 2019): S37. http://dx.doi.org/10.1017/cem.2019.123.
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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, emergency department (ED) funding and workload models. The electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes that application of national triage guidelines across Ontario. The objective of this study was to evaluate triage times and score agreement in ED settings where eCTAS has been implemented. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1491 (752 pre-eCTAS, 739 post-implementation) individual patient CTAS assessments were audited over 42 (21 pre-eCTAS, 21 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 567 (75.4%) patients pre-eCTAS, compared to 685 (92.7%) patients triaged with eCTAS. Using the auditor's CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.0% vs. 5.1%; Δ 6.9, 95% CI: 4.0, 9.7) and under-triaged (12.6% vs. 2.2%; Δ 10.4, 95% CI: 7.9, 13.2). Interrater agreement was higher with eCTAS (unweighted kappa 0.89 vs 0.63; quadratic-weighted kappa 0.91 vs. 0.71). Research assistants captured triage time for 3808 patients pre-eCTAS and 3489 post implementation of eCTAS. Median triage time was 312 seconds pre-eCTAS and 347 seconds with eCTAS (Δ 35 seconds, 95% CI: 29, 40 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
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Patel, Vimla L., Lily A. Gutnik, Daniel R. Karlin, and Martin Pusic. "Calibrating urgency: triage decision-making in a pediatric emergency department." Advances in Health Sciences Education 13, no. 4 (March 16, 2007): 503–20. http://dx.doi.org/10.1007/s10459-007-9062-6.
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Bell, Fiona, Richard Pilbery, Rob Connell, Dean Fletcher, Tracy Leatherland, Linda Cottrell, and Peter Webster. "PP35 The acceptability and safety of video triage for ambulance service patients and clinicians during the covid-19 pandemic: a service evaluation." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A15.1—A15. http://dx.doi.org/10.1136/emermed-2021-999.35.
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IntroductionIn response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust (YAS) introduced video call technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the Emergency Operations Centre (EOC). We aimed to investigate patient and staff acceptability of video triage, and the safety of the decision-making process.MethodsThis service evaluation utilised a mixture of routine 999 call and bespoke data collection from participating clinicians who logged calls they both attempted and undertook. We sent postal surveys to a group of patients who were recipients of a video triage.ResultsBetween 27th March 2020 and 25th August 2020 clinicians documented 1073 video triage calls. A successful video triage call was achieved in 641 (59.7%) of cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) viewed the technology, the ambulance staff and the care planning favourably.Callers receiving video triage that ended with a disposition of ‘hear and treat’, had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical support desk telephone triage alone (16/212, 7.5% vs 2508/14349, 17.5% respectively.)ConclusionIn this single NHS Ambulance Trust evaluation, the use of video triage for low acuity calls appeared to be safe, with low rates of recontact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate or acceptable to patients and technical issues were not uncommon.
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McLeod, S. L., J. McCarron, K. Stein, S. Scott, H. J. Ovens, N. Mittman, and B. Borgundvaag. "LO75: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score in 7 emergency departments." CJEM 19, S1 (May 2017): S54. http://dx.doi.org/10.1017/cem.2017.137.
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Introduction: The Canadian Triage and Acuity Scale (CTAS) is the standard used in all Canadian (and many international) emergency departments (EDs) for establishing the priority by which patients should be assessed. In addition to its clinical utility, CTAS has become an important administrative metric used by governments to estimate patient care requirements, ED funding and workload models. Despite its importance, the process by which CTAS scores are derived is highly variable. Emphasis on ED wait times has also drawn attention to the length of time the triage process takes. The primary objective of this study was to determine the interrater agreement of CTAS in current clinical practice. The secondary objective was to determine the time it takes to triage in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 738 consecutive patient CTAS assessments were audited over 21 seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients. Using the auditor’s CTAS score as the reference standard, on-duty triage nurses over-triaged 89 (12.1%) and under-triaged 95 (12.9%) patients. Interrater agreement was “good” with an unweighted kappa of 0.63 (95% CI: 0.58, 0.67) and quadratic-weighted kappa of 0.79 (95% CI: 0.67, 0.90). Research assistants captured triage time for 3808 patients over 69 shifts at 7 different EDs. Median (IQR) triage time was 5.2 (3.8, 7.3) minutes and ranged from 3.9 (3.1, 4.8) minutes to 7.5 (5.8, 10.8) minutes. Conclusion: Variability in the accuracy, and length of time taken to perform CTAS assessments suggest that a standardized approach to performing CTAS assessments would improve both clinical decision making, and administrative data accuracy.
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Erika, Poggiali, Vercelli Andrea, Maria Grazia Cillis, Eva Ioannilli, Teresa Iannicelli, and Magnacavallo Andrea. "Triage decision-making at the time of COVID-19 infection: the Piacenza strategy." Internal and Emergency Medicine 15, no. 5 (May 9, 2020): 879–82. http://dx.doi.org/10.1007/s11739-020-02350-y.
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Kenny, Nuala, Jaro Kotalik, Leonie Herx, Ramona Coelho, and Rene Leiva. "A Catholic Perspective: Triage Principles and Moral Distress in Pandemic Scarcity." Linacre Quarterly 88, no. 2 (March 11, 2021): 214–23. http://dx.doi.org/10.1177/0024363921995714.
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Striving to be faithful to the moral core of medicine and to spiritual, moral, and social teaching of the church, Catholic physicians see their role as an extension of the healing ministry of Jesus. When faced with a situation in which a large number of gravely ill people are seeking care, but optimal treatment such as ventilation in intensive care unit cannot be offered to all because of scarcity of resources, Catholic physicians recognize the need to consider the common good and to assign a priority to patients for whom such treatments would be most probably lifesaving. Making these evaluations, physicians will use only objective medical criteria regarding the benefits and risks to patients and will be mindful that all persons deserve equal respect for their dignity. Discrimination or prejudicial treatment against patients based on factors such as age, disability, race, gender, quality of life, and possible long-term survival cannot be morally justified. Triage process should incorporate respect for autonomy of both the patient and the professional and opportunity for an appeal of a triage decision. Other principles and values that will affect how a triage protocol is developed and applied are proportionality, equity, reciprocity, solidarity, subsidiarity, and transparency. The current coronavirus pandemic can provide valuable lessons and stimulus for reforms and renewal. Summary: Catholic physicians strive to continue the healing ministry of Jesus Christ and be faithful to the moral core of medicine. In situations such as pandemic, the scarcity of personnel and technological resources create serious challenges and even moral distress. Church teachings on dignity, the common good and protection of the vulnerable help guide decisions based on public medical criteria and shared decision-making.
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Vinay, Rasita, Holger Baumann, and Nikola Biller-Andorno. "Ethics of ICU triage during COVID-19." British Medical Bulletin 138, no. 1 (May 31, 2021): 5–15. http://dx.doi.org/10.1093/bmb/ldab009.
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Abstract Introduction The coronavirus disease 2019 pandemic has placed intensive care units (ICU) triage at the center of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria—e.g. medical prognosis, age, life-expectancy or quality of life—are ethically acceptable. The paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. Sources of data Published articles, news articles, book chapters, ICU triage guidelines set out by professional societies and health authorities. Areas of agreement Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served policy or quality-adjusted life-years and (ii) to rely on medical prognosis, maximizing lives saved, justice as fairness and non-discrimination. Areas of controversy Points of disagreement in existing guidelines and the ethics literature more broadly regard the use of exclusion criteria, the role of life expectancy, the prioritization of healthcare workers and the reassessment of triage decisions. Growing points Improve outcome predictions, possibly aided by Artificial intelligence (AI); develop participatory approaches to drafting, assessing and revising triaging protocols; learn from experiences with implementation of guidelines with a view to continuously improve decision-making. Areas timely for developing research Examine the universality vs. context-dependence of triaging principles and criteria; empirically test the appropriateness of triaging guidelines, including impact on vulnerable groups and risk of discrimination; study the potential and challenges of AI for outcome and preference prediction and decision-support.
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Rottman, Steven J., Kimberley I. Shoaf, Jennifer Schlesinger, Eva Klein Selski, Joey Perman, Kerry Lamb, and Janet Cheng. "Pandemic Influenza Triage in the Clinical Setting." Prehospital and Disaster Medicine 25, no. 2 (April 2010): 99–104. http://dx.doi.org/10.1017/s1049023x00007792.
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AbstractIntroduction:There has been much federal and local health planning for an influenza pandemic in the United States, but little is known about the ability of the clinical community to deal quickly and effectively with a potentially overwhelming surge of pandemic influenza patients.Problem:The attitudes and expectations of emergency physicians, emergency nurses, hospital nursing supervisors, hospital administrators, and infection control personnel concerning clinical care in a pandemic were assessed.Methods:Key informant structured interviews of 46 respondents from 34 randomly selected emergency receiving hospitals in Los Angeles County were conducted using an Institutional Review Board-approved protocol. The interview asked about supplies/resources, triage, quality of care, and decision-making. At the conclusion of each interview, the informant was asked to provide the contact information for at least two others within their respective professional group. Interviews were transcribed and coded for key themes using qualitative analytical software.Results:There was little salience that an influx of variably ill patients with influenza would force stratified healthcare decision-making. There also was a general lack of preparation to address the ethics and practices of triaging patients in the clinical setting of a pandemic.Conclusions:Guidelines must be developed in concert with public health, medical society, and legislative authorities to help clinicians define, adopt, and communicate to the public those practice standards that will be followed in a mass population, infectious disease emergency.
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Trinh, Tina, Amira Elfergani, and Maralyssa Bann. "Qualitative analysis of disposition decision making for patients referred for admission from the emergency department without definite medical acuity." BMJ Open 11, no. 7 (July 2021): e046598. http://dx.doi.org/10.1136/bmjopen-2020-046598.
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ObjectiveTo map the physician approach when determining disposition for a patient who presents without the level of definite medical acuity that would generally warrant hospitalisation.Data sources/study settingSince 2018, our US academic county hospital/trauma centre has maintained a database in which hospitalists (‘triage physicians’) document the rationale and outcomes of requests for admission to the acute care medical ward during each shift.Study designNarrative text from the database was analysed using a grounded theory approach to identify major themes and subthemes, and a conceptual model of the admission decision-making process was constructed.ParticipantsDatabase entries were included (n=300) if the admission call originated from the emergency department and if the triage physician characterised the request as potentially inappropriate because the patient did not have definite medical acuity.ResultsAdmission decision making occurs in three main phases: evaluation of unmet needs, assessment of risk and re-evaluation. Importantly, admission decision making is not solely based on medical acuity or clinical algorithms, and patients without a definite medical need for admission are hospitalised when physicians believe a potential issue exists if discharged. In this way, factors such as homelessness, substance use disorder, frailty, etc, contribute to admission because they raise concern about patient safety and/or barriers to appropriate treatment. Physician decision making can be altered by activities such as care coordination, advocacy by the patient or surrogate, interactions with other physicians or a change in clinical trajectory.ConclusionsThe decision to admit ultimately remains a clinical determination constructed between physician and patient. Physicians use a holistic process that incorporates broad consideration of the patient’s medical and social needs with emphasis on risk assessment; thus, any analysis of hospitalisation trends or efforts to impact such should seek to understand this individual-level decision making.
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Hong, Paul, Krista Ritchie, Cathy Beaton-Campbell, Lynn Cavanagh, James Belyea, and Gerard Corsten. "The effectiveness of nurse-led outpatient referral triage decision making in pediatric otolaryngology." International Journal of Pediatric Otorhinolaryngology 79, no. 4 (April 2015): 576–78. http://dx.doi.org/10.1016/j.ijporl.2015.01.031.
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Jaslow, David, Nathaniel Zahustecher, Fred Ellinger, Derek Zecher, and Ryan Overberger. "An Emergency Medical Triage Tool for Swiftwater Rescue." Prehospital and Disaster Medicine 34, s1 (May 2019): s125—s126. http://dx.doi.org/10.1017/s1049023x19002711.
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Introduction:Climate change and overdevelopment increase the intensity and frequency of flash flooding, which may generate more swiftwater rescue (SWR) incidents. Rescue personnel may fail to properly risk stratify (triage) these victims due to limited medical and/or variable SWR training, or due to an adverse rescuer-to-victim ratio. Some victims may attempt to refuse medical evaluation due to lack of awareness of incident-related morbidity and/or comprehension of risk.Aim:To develop an SWR emergency medical triage tool.Methods:A cross-sectional literature search identified SWR-related medical conditions. A flow diagram reliant upon incident history, chief complaint, and observational exam rather than interpretation of vital signs was created to guide medical decision-making.Results:Every SWR victim should receive a medical screening exam focused on six clinical categories—drowning, hypothermia, hazmat exposure, physical trauma, psychological trauma and exacerbation of pre-existing disease. Drowning potential is identified by dyspnea, new cough or a history of (even brief) submersion. Shivering SWR victims and those with altered mental status but no shivering are assumed to be hypothermic. Any victim with open skin lesions/wounds who was immersed in floodwater and anyone who has swallowed floodwater is contaminated; these victims require decontamination and possible antibiotic therapy. SWR victims injured upon entering the water or from contact with either water-borne stationary or floating objects require trauma evaluation. Distraught victims and those who exhibit exacerbation of pre-existing organ-system disease also require ED evaluation.Discussion:Most SWR course curricula are oriented towards technical rescue; they do not address comprehensive medical decision-making. We present a rapid medical screening exam designed to determine which SWR victims require an ED evaluation. Such a triage tool will assist rescuers to simultaneously honor patient autonomy and avoid risky and uninformed refusal of medical aid. Simplified medical decision-making should enable the application of this tool worldwide.
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Gopalan, Pragasan Dean, and Santosh Pershad. "Decision-making in ICU – A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions." Journal of Critical Care 50 (April 2019): 99–110. http://dx.doi.org/10.1016/j.jcrc.2018.11.027.
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Fry, Margaret, and Colleen Stainton. "An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes." Accident and Emergency Nursing 13, no. 4 (October 2005): 214–19. http://dx.doi.org/10.1016/j.aaen.2005.09.004.
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Heyningen, Carl Leith van. "1690 Can triage based interventions reduce length of stay in a paediatric emergency department? A literature review." Emergency Medicine Journal 39, no. 12 (November 22, 2022): A981—A982. http://dx.doi.org/10.1136/emermed-2022-rcem2.34.
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Aims, Objectives and BackgroundIn a busy paediatric emergency department triage decisions are critical to patient flow (see figure 1). In addition to sorting patients by acuity the initiation of early interventions at triage is pivotal. Effective use of triage has the potential to significantly reduce lengths of stay.1,2Method and DesignAdhering to PRISMA guidelines, we utilised the key words ‘children’, ‘triage’ and ‘length of stay’ to search the MEDLINE and COCHRANE databases for relevant studies. Inclusion and exclusion criteria allowed a focused interrogation of the literature over the last two decades. Bibliographies & specialist journals were also searched to prevent important omissions.Results and ConclusionNine studies (two randomised controlled trials, seven non randomised) were found. Interventions included; reallocated staff for triage, a paediatrician in triage and a series of triage nurse initiated treatments, investigations and protocols. Average reductions in emergency department length of stay ranged from four to forty four minutes per patient.The common principle identified was early decision making. Statistical significance was demonstrated with few exceptions. Estimates of bias were low. The quality of evidence was high.Limitations included; uneven benefit (e.g. whilst overall length of stay was reduced, some patients waited longer) and over treatment. Triage nurse initiated treatment stood out as as having the most impact with the least additional cost. There were no adverse incidents.Triage based interventions are an important strategy in reducing the length of stay for children attending an emergency department. Doing so represents a proactive step in tackling the growing problem of overcrowding in the paediatric emergency department.ReferencesHaybarker B (2015). Reducing Emergency Department Length of Stay by System Change. Walden Dissertations and Doctoral Studies [Accessed 27/7/21]RCEM Tackling Emergency Department Crowding December 2015 [Accessed 27/7/21], Available at https://rcem.ac.uk/wp-content/uploads/2021/10/ED_Crowding_Overview_and_Toolkit_Dec2015.pdf
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Sprung, Charles L., Mario Baras, Gaetano Iapichino, Jozef Kesecioglu, Anne Lippert, Chris Hargreaves, Angelo Pezzi, et al. "The Eldicus prospective, observational study of triage decision making in European intensive care units." Critical Care Medicine 40, no. 1 (January 2012): 125–31. http://dx.doi.org/10.1097/ccm.0b013e31822e5692.
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Teff, Richard J. "Use of neurosurgical decision-making and damage-control neurosurgery courses in the Iraq and Afghanistan conflicts: a surgeon's experience." Neurosurgical Focus 28, no. 5 (May 2010): E9. http://dx.doi.org/10.3171/2010.2.focus1017.
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A shortage of Coalition neurological surgeons in the Iraq conflict prompted a creative approach to standardized neurosurgical care in 2007. After formulation of theater-wide clinical pathway guidelines, a need for standardized triage and neurological resuscitation was identified. The object was to establish a simple, reproducible course for medics, forward surgical and emergency room personnel, and other critical care providers to quickly standardize the ability of all deployed health care personnel to provide state-of-the-art neurosurgical triage and damage-control interventions. The methods applied were Microsoft PowerPoint presentations and hands-on learning. The year-long project resulted in more than 100 individuals being trained in neurosurgical decision making and in more than 15 surgeons being trained in damage-control neurosurgery. At the year's conclusion, hundreds of individuals received exceptional neurosurgical care from nonneurosurgical providers and a legacy course was left for future deployed providers to receive ongoing education at their own pace.
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Arslanian-Engoren, Cynthia, and Bonnie M. Hagerty. "The Development and Testing of the Nurses’ Cardiac Triage Instrument." Research and Theory for Nursing Practice 27, no. 1 (2013): 9–18. http://dx.doi.org/10.1891/1541-6577.27.1.9.
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Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. The purpose of this study was to develop and test the psychometric properties of a new theoretically driven, empirically based instrument for measuring nurses’ cardiac triage decisions. Using a descriptive research design, data were collected using a mailed survey. There were 158 ED nurses who completed a mailed questionnaire. Factor analysis revealed three factors (patient presentation, unbiased nurse reasoning process, and nurse action) with good internal consistency (Cronbach’s α = .903, .809, .718) and sample adequacy (KMO = .758) of the 30-item instrument. The newly developed instrument has the potential to improve patient outcomes surrounding early MI identification and treatment.
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Grigg, Margaret, Helen Herrman, and Carol Harvey. "What is Duty/Triage? Understanding the Role of Duty/Triage in an Area Mental Health Service." Australian & New Zealand Journal of Psychiatry 36, no. 6 (December 2002): 787–91. http://dx.doi.org/10.1046/j.1440-1614.2002.01088.x.
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Objective: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment. Method: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed. Quantitative and qualitative analyses were conducted. Results: Two thousand, six hundred and three contacts with duty/triage occurred over a 3-month period. Half of these were related to patients new to the service. Most contacts were self-referrals or referrals from a carer. Few referrals came through the primary health care sector. New patients were more likely to be assessed if the referral was presented in technical language and if it was initiated by a health professional, particularly a general practitioner, emergency department or other mental health service. Assessment was less likely if the patient or carer initiated the referral, if the problem was presented in vague or non-technical terms, if there was a drug or alcohol problem or if the person refused care. Conclusions: A substantial number of potential patients contact a duty/triage worker every day. However, there is little interaction with the primary care sector, limited documentation of risk and a lack of consistency in the documented reasons for the service response. Further investigation is needed of the conditions conducive to consistent quality decision making at the point of entry to a specialist mental health service.
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Gerdtz, M. F., and T. K. Bucknall. "Why we do the things we do: Applying clinical decision-making frameworks to triage practice." Accident and Emergency Nursing 7, no. 1 (January 1999): 50–57. http://dx.doi.org/10.1016/s0965-2302(99)80103-9.
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Chung, Josephine Y. M. "An exploration of accident and emergency nurse experiences of triage decision making in Hong Kong." Accident and Emergency Nursing 13, no. 4 (October 2005): 206–13. http://dx.doi.org/10.1016/j.aaen.2005.08.003.
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Tsai, Dung-Jang, Shih-Hung Tsai, Hui-Hsun Chiang, Chia-Cheng Lee, and Sy-Jou Chen. "Development and Validation of an Artificial Intelligence Electrocardiogram Recommendation System in the Emergency Department." Journal of Personalized Medicine 12, no. 5 (April 27, 2022): 700. http://dx.doi.org/10.3390/jpm12050700.
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The machine learning-assisted electrocardiogram (ECG) is increasingly recognized for its unprecedented capabilities in diagnosing and predicting cardiovascular diseases. Identifying the need for ECG examination early in emergency department (ED) triage is key to timely artificial intelligence-assisted analysis. We used machine learning to develop and validate a clinical decision support tool to predict ED triage patients’ need for ECG. Data from 301,658 ED visits from August 2017 to November 2020 in a tertiary hospital were divided into a development cohort, validation cohort, and two test cohorts that included admissions before and during the COVID-19 pandemic. Models were developed using logistic regression, decision tree, random forest, and XGBoost methods. Their areas under the receiver operating characteristic curves (AUCs), positive predictive values (PPVs), and negative predictive values (NPVs) were compared and validated. In the validation cohort, the AUCs were 0.887 for the XGBoost model, 0.885 for the logistic regression model, 0.878 for the random forest model, and 0.845 for the decision tree model. The XGBoost model was selected for subsequent application. In test cohort 1, the AUC was 0.891, with sensitivity of 0.812, specificity of 0.814, PPV of 0.708 and NPV of 0.886. In test cohort 2, the AUC was 0.885, with sensitivity of 0.816, specificity of 0.812, PPV of 0.659, and NPV of 0.908. In the cumulative incidence analysis, patients not receiving an ECG yet positively predicted by the model had significantly higher probability of receiving the examination within 48 h compared with those negatively predicted by the model. A machine learning model based on triage datasets was developed to predict ECG acquisition with high accuracy. The ECG recommendation can effectively predict whether patients presenting at ED triage will require an ECG, prompting subsequent analysis and decision-making in the ED.
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Lyons, RN, MSL, Wendy H., Frederick M. Burkle Jr, MD, MPH, DTM, FAAP, FACEP, Deborah L. Roepke, MPA, and James E. Bertz, MD, DDS, FACS. "An influenza pandemic exercise in a major urban setting, Part I: Hospital health systems lessons learned and implications for future planning." American Journal of Disaster Medicine 4, no. 2 (March 1, 2009): 120–28. http://dx.doi.org/10.5055/ajdm.2009.0018.
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A 2007 pandemic exercise in Maricopa County, Arizona, the 5th largest urban population in the United States, revealed major vulnerabilities in planning, response, resource utilization, and the decision-making process, which would be common to any large urban setting where multiple independent organizations exist and have not yet coordinated or shared their plans. Communication challenges are both prevalent and magnified in large urban settings.There must be tough, broad-based decision making by healthcare leadership with guidance and processes at every level to assure compliance to the primary goals of pandemic flu plans necessary to control the transmission rate of the disease. A unifying decision-making element such as a Healthrelated Emergency Operations Center is critical for the coordination, which serves all urban health systems. Education and training in pre-event protocols for triage management is crucial at every level where resources will be scant. This is especially true in admissions to intensive care units and priorities for ventilator use.
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Lyons, RN, MSL, Wendy H., Frederick M. Burkle Jr, MD, MPH, DTM, FAAP, FACEP, Deborah L. Roepke, MPA, and James E. Bertz, MD, DDS, FACS. "An influenza pandemic exercise in a major urban setting, Part I: Hospital health systems lessons learned and implications for future planning." American Journal of Disaster Medicine 14, no. 4 (October 1, 2019): 299–307. http://dx.doi.org/10.5055/ajdm.2019.0343.
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A 2007 pandemic exercise in Maricopa County, Arizona, the 5th largest urban population in the United States, revealed major vulnerabilities in planning, response, resource utilization, and the decision-making process, which would be common to any large urban setting where multiple independent organizations exist and have not yet coordinated or shared their plans. Communication challenges are both prevalent and magnified in large urban settings. There must be tough, broad-based decision making by healthcare leadership with guidance and processes at every level to assure compliance to the primary goals of pandemic flu plans necessary to control the transmission rate of the disease. A unifying decision-making element such as a Health-related Emergency Operations Center is critical for the coordination, which serves all urban health systems. Education and training in pre-event protocols for triage management is crucial at every level where resources will be scant. This is especially true in admissions to intensive care units and priorities for ventilator use.
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Chen, Fujuan, Xueying Xiao, Youshan Ni, Yanan Zhu, and Xiao Li. "Analysis of Risk Factors of Hospital Emergency Nursing Based on Comprehensive Nursing Methods." Computational and Mathematical Methods in Medicine 2021 (December 14, 2021): 1–11. http://dx.doi.org/10.1155/2021/1077358.
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In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.
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van Rein, Eveline A. J., Said Sadiqi, Koen W. W. Lansink, Rob A. Lichtveld, Risco van Vliet, F. Cumhur Oner, Luke P. H. Leenen, and Mark van Heijl. "The role of emergency medical service providers in the decision-making process of prehospital trauma triage." European Journal of Trauma and Emergency Surgery 46, no. 1 (September 20, 2018): 131–46. http://dx.doi.org/10.1007/s00068-018-1006-8.
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Sprung, Charles L., Antonio Artigas, Jozef Kesecioglu, Angelo Pezzi, Joergen Wiis, Romain Pirracchio, Mario Baras, et al. "The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II." Critical Care Medicine 40, no. 1 (January 2012): 132–38. http://dx.doi.org/10.1097/ccm.0b013e318232d6b0.
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Rendell, Kathryn, Irena Koprinska, Andre Kyme, Anja A. Ebker‐White, and Michael M. Dinh. "The Sydney Triage to Admission Risk Tool (START2) using machine learning techniques to support disposition decision‐making." Emergency Medicine Australasia 31, no. 3 (November 23, 2018): 429–35. http://dx.doi.org/10.1111/1742-6723.13199.
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Cherkashin, M. A., I. S. Scheparev, N. S. Berezin, N. A. Berezina, and A. A. Nikolaev. "The role of «point of care ultrasound» in medical triage of COVID-19 patients: a systematic review." Diagnostic radiology and radiotherapy 13, no. 2 (June 30, 2022): 16–24. http://dx.doi.org/10.22328/2079-5343-2022-13-2-16-24.
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INTRODUCTION: In the conditions of primary triage of patients with the new coronavirus infection, various medical imaging methods, including «point of care ultrasound», have become key.OBJECTIVE: The aim of this paper is to review data published during the pandemic on the assessment of the role of various ultrasound diagnostic methods in medical triage of patients with COVID-19.MATERIALS AND METHODS: The authors performed a systematic literature search in Russian and English for the period up to March 10, 2022 using various databases and repositories (Embase, Medline/PubMed, Researchgate, medrxiv.org, RSCI/elibrary). The search was carried out on the keywords «COVID-19», «coronavirus», «коронавирус», «SARS-CoV-2», «2019nCOV», «lung ultrasound», «POCUS», «point of care ultrasound», «прикроватный ультразвук», «ультразвуковое сканирование легких», «triage», «сортировка».RESULTS: The final analysis included 42 publications on different aspects of the use of point of care ultrasound during the pandemic. Of considerable interest are the technical features of the research, classifications and triage algorithms used in different countries.CONCLUSION: The widespread introduction of «point of care ultrasound» technology in the prehospital, emergency department and intensive care units greatly facilitates clinical decision making, including in the initial assessment of the severity of the condition of patients with pneumonia caused by SARS-CoV-2.
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Harthi, Naif, Steve Goodacre, Fiona C. Sampson, and Rayan Alharbi. "PP15 Research priorities for prehospital care of older patients with injuries: scoping review." Emergency Medicine Journal 39, no. 9 (August 23, 2022): e5.7. http://dx.doi.org/10.1136/emermed-2022-999.15.
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BackgroundThe use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature.MethodsA systematic scoping review guided by the Arksey and O’Malley framework reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between (2001-2021) years. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles.Results65 studies were identified and reviewed, and 25 included. Five categories were identified: ‘field triage, ‘ageing impacts’, ‘decision-making’, ‘paramedic’ awareness’ and ‘paramedic’s behaviour’. Undertriage & overtriage (sensitivity & specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. More research is required into paramedic knowledge of geriatric care & ageing changes and the potential impact of paramedic care.ConclusionThis is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. This review has identified the prehospital triage for older trauma victims and studies of paramedic knowledge of older trauma care as key priorities. Investigating and understanding these can improve providing prehospital care of the older patient with injuries for positive patient outcomes.
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Harthi, Naif, Steve Goodacre, Fiona Sampson, and Rayan Alharbi. "755 Research priorities for prehospital care of older patients with injuries: scoping review." Emergency Medicine Journal 39, no. 3 (February 21, 2022): 253.2–253. http://dx.doi.org/10.1136/emermed-2022-rcem.22.
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Introduction and purposeThe use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature.MethodsA systematic scoping review guided by the Arksey and O’Malley framework reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between (2001–2021) years. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles.Results65 studies were identified and reviewed, and 25 included. Five categories were identified: ‘field triage, ‘ageing impacts’, ‘decision-making’, ‘paramedic’ awareness’ and ‘paramedic’s behaviour’. Undertriage & overtriage (sensitivity & specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. More research is required into paramedic knowledge of geriatric care & ageing changes and the potential impact of paramedic care.ConclusionThis is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. This review has identified the prehospital triage for older trauma victims and studies of paramedic knowledge of older trauma care as key priorities. Investigating and understanding these can improve providing prehospital care of the older patient with injuries for positive patient outcomes.
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Marincowitz, Carl, Laura Sutton, Tony Stone, Richard Pilbery, Richard Campbell, Benjamin Thomas, Janette Turner, et al. "Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study." Emergency Medicine Journal 39, no. 4 (February 9, 2022): 317–24. http://dx.doi.org/10.1136/emermed-2021-211934.
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BackgroundTools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting.MethodsAn observational cohort study using linked ambulance service data for patients attended by Emergency Medical Service (EMS) crews in the Yorkshire and Humber region of England between 26 March 2020 and 25 June 2020 was conducted to assess performance of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) tool, National Early Warning Score (NEWS2), WHO algorithm, CRB-65 and Pandemic Medical Early Warning Score (PMEWS) in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support.ResultsOf the 7549 patients in our cohort, 17.6% (95% CI 16.8% to 18.5%) experienced the primary outcome. The NEWS2 (National Early Warning Score, version 2), PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40).ConclusionUse of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.
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Bertrand, Sharon W. "Registered Nurses Integrate Traditional Chinese Medicine Into the Triage Process." Qualitative Health Research 22, no. 2 (September 2, 2011): 263–73. http://dx.doi.org/10.1177/1049732311421681.
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People in the United States often consult registered nurses (nurses) for advice when they want to explore alternatives to Western medicine, such as traditional Chinese medicine (TCM). Nurses find themselves confronting dilemmas when they are caught between these radically different worlds of medical cultures and thinking. Twenty Minnesota nurses were interviewed to learn how they integrate TCM into their triage process. Symbolic interactionism was the research framework used, and mixed coding methods facilitated data analysis. Several sociological theories explain the findings. The major finding is that nurses use a four-step triage process that begins from the Western medical perspective and includes consideration of TCM use. Nurses’ recommendations are influenced by their situational roles and relationships, and by the cues they read from the person who is asking their advice. The results point to nurses being natural disseminators of TCM information and education in their resource role for others making health care decisions.
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Karlafti, Eleni, Athanasios Anagnostis, Theodora Simou, Angeliki Sevasti Kollatou, Daniel Paramythiotis, Georgia Kaiafa, Triantafyllos Didaggelos, Christos Savvopoulos, and Varvara Fyntanidou. "Support Systems of Clinical Decisions in the Triage of the Emergency Department Using Artificial Intelligence: The Efficiency to Support Triage." Acta medica Lituanica 30, no. 1 (January 24, 2023): 2. http://dx.doi.org/10.15388/amed.2023.30.1.2.
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Purpose: In the Emergency Departments (ED) the current triage systems that are been implemented are based completely on medical education and the perception of each health professional who is in charge. On the other hand, cutting-edge technology, Artificial Intelligence (AI) can be incorporated into healthcare systems, supporting the healthcare professionals’ decisions, and augmenting the performance of triage systems. The aim of the study is to investigate the efficiency of AI to support triage in ED.Patients–Methods: The study included 332 patients from whom 23 different variables related to their condition were collected. From the processing of patient data for input variables, it emerged that the average age was 56.4 ± 21.1 years and 50.6% were male. The waiting time had an average of 59.7 ± 56.3 minutes while 3.9% ± 0.1% entered the Intensive Care Unit (ICU). In addition, qualitative variables related to the patient’s history and admission clinics were used. As target variables were taken the days of stay in the hospital, which were on average 1.8 ± 5.9, and the Emergency Severity Index (ESI) for which the following distribution applies: ESI: 1, patients: 2; ESI: 2, patients: 18; ESI: 3, patients: 197; ESI: 4, patients: 73; ESI: 5, patients: 42.Results: To create an automatic patient screening classifier, a neural network was developed, which was trained based on the data, so that it could predict each patient’s ESI based on input variables.The classifier achieved an overall accuracy (F1 score) of 72.2% even though there was an imbalance in the classes.Conclusions: The creation and implementation of an AI model for the automatic prediction of ESI, highlighted the possibility of systems capable of supporting healthcare professionals in the decision-making process. The accuracy of the classifier has not reached satisfactory levels of certainty, however, the performance of similar models can increase sharply with the collection of more data.
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Ong, Elena Ying Ern, Daniel Ying Yao Ong, Mohammed Abdul Waduud, and Wen Ling Choong. "Ten tips for foundation doctors when making inpatient referrals to surgical specialties." Postgraduate Medical Journal 96, no. 1134 (January 30, 2020): 228–31. http://dx.doi.org/10.1136/postgradmedj-2019-137346.
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Making referrals to another specialty is an underemphasised skill in the undergraduate medical curriculum. As a result, many new foundation doctors find themselves ill-equipped to make effective referrals to other specialties as part of their day-to-day responsibilities. This can often be frustrating to the foundation doctor, the specialist and contribute to critical delays in patient care. Surgical registrars are required to triage patients (for urgent review or even to take to theatre) often under time and high patient volume pressures. As such, it is imperative for foundation doctors to make referrals as efficiently as possible to facilitate surgical specialty decision making and, ultimately, to expedite medical care to patients. In this article, we describe 10 tips for the foundation doctor in making inpatient referrals to surgical specialties.
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Meadmore, Katie, Kathryn Fackrell, Alejandra Recio-Saucedo, Abby Bull, Simon D. S. Fraser, and Amanda Blatch-Jones. "Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice." PLOS ONE 15, no. 11 (November 5, 2020): e0239757. http://dx.doi.org/10.1371/journal.pone.0239757.
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Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.
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Broome, Laura, Jason Davies, and Mark Lewis. "Service evaluation of the South Wales police control room mental health triage model: outcomes achieved, lessons learned and next steps." Journal of Forensic Practice 24, no. 2 (February 7, 2022): 95–110. http://dx.doi.org/10.1108/jfp-09-2021-0049.
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Purpose South Wales Police Mental Health (MH) Triage service was initiated to meet the Welsh Government MH priority of early intervention to prevent MH crisis. Community Psychiatric Nurses, based in the control-room, provide advice to police and control room staff on the management of MH-related incidents. The purpose of this paper is to evaluate the first 12 months of operation (January-December 2019). Design/methodology/approach Service evaluation of the first 12 months of operation (January–December 2019). Data were analysed in relation to: MH incidents; repeat callers; Section (S)136 use/assessment outcomes. Police, health staff and triage service users were interviewed and surveyed to capture their opinions of the service. Findings Policing areas with high engagement in triage saw reductions in S136 use and estimated opportunity costs saving. Triage was considered a valuable service that promoted cross agency collaborations. De-escalation in cases of mental distress was considered a strength. Access to follow-on services was identified as a challenge. Practical implications Triage enables a multi-agency response in the management of MH-related incidents. Improving trust between services, with skilled health professionals supporting police decision-making in real time. Originality/value There is a gap in the research on the impact of police-related MH triage models beyond the use of S136. This project evaluated the quality of the service, its design and the relationship between health, police and partner agencies during the triage process. Multi-agency assessment of follow-up is needed to measure the long-term impact on services and users.
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Jmaa, Maissa Ben, Houda Ben Ayed, Mondher Kassis, Mariem Ben Hmida, Maroua Trigui, Hanen Maamri, Nouha Ketata, et al. "Epidemiological profile and performance of triage decision-making process of COVID-19 suspected cases in southern Tunisia." African Journal of Emergency Medicine 12, no. 1 (March 2022): 1–6. http://dx.doi.org/10.1016/j.afjem.2021.10.001.
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Konchak, Chad W., Jacob Krive, Loretta Au, Daniel Chertok, Priya Dugad, Gus Granchalek, Ekaterina Livschiz, et al. "From Testing to Decision-Making: A Data-Driven Analytics COVID-19 Response." Academic Pathology 8 (January 1, 2021): 237428952110102. http://dx.doi.org/10.1177/23742895211010257.
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In March 2020, NorthShore University Health System laboratories mobilized to develop and validate polymerase chain reaction based testing for detection of SARS-CoV-2. Using laboratory data, NorthShore University Health System created the Data Coronavirus Analytics Research Team to track activities affected by SARS-CoV-2 across the organization. Operational leaders used data insights and predictions from Data Coronavirus Analytics Research Team to redeploy critical care resources across the hospital system, and real-time data were used daily to make adjustments to staffing and supply decisions. Geographical data were used to triage patients to other hospitals in our system when COVID-19 detected pavilions were at capacity. Additionally, one of the consequences of COVID-19 was the inability for patients to receive elective care leading to extended periods of pain and uncertainty about a disease or treatment. After shutting down elective surgeries beginning in March of 2020, NorthShore University Health System set a recovery goal to achieve 80% of our historical volumes by October 1, 2020. Using the Data Coronavirus Analytics Research Team, our operational and clinical teams were able to achieve 89% of our historical volumes a month ahead of schedule, allowing rapid recovery of surgical volume and financial stability. The Data Coronavirus Analytics Research Team also was used to demonstrate that the accelerated recovery period had no negative impact with regard to iatrogenic COVID-19 infection and did not result in increased deep vein thrombosis, pulmonary embolisms, or cerebrovascular accident. These achievements demonstrate how a coordinated and transparent data-driven effort that was built upon a robust laboratory testing capability was essential to the operational response and recovery from the COVID-19 crisis.
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Liu, Nan, Feng Xie, Fahad Javaid Siddiqui, Andrew Fu Wah Ho, Bibhas Chakraborty, Gayathri Devi Nadarajan, Kenneth Boon Kiat Tan, and Marcus Eng Hock Ong. "Leveraging Large-Scale Electronic Health Records and Interpretable Machine Learning for Clinical Decision Making at the Emergency Department: Protocol for System Development and Validation." JMIR Research Protocols 11, no. 3 (March 25, 2022): e34201. http://dx.doi.org/10.2196/34201.
Full textAbstract:
Background There is a growing demand globally for emergency department (ED) services. An increase in ED visits has resulted in overcrowding and longer waiting times. The triage process plays a crucial role in assessing and stratifying patients’ risks and ensuring that the critically ill promptly receive appropriate priority and emergency treatment. A substantial amount of research has been conducted on the use of machine learning tools to construct triage and risk prediction models; however, the black box nature of these models has limited their clinical application and interpretation. Objective In this study, we plan to develop an innovative, dynamic, and interpretable System for Emergency Risk Triage (SERT) for risk stratification in the ED by leveraging large-scale electronic health records (EHRs) and machine learning. Methods To achieve this objective, we will conduct a retrospective, single-center study based on a large, longitudinal data set obtained from the EHRs of the largest tertiary hospital in Singapore. Study outcomes include adverse events experienced by patients, such as the need for an intensive care unit and inpatient death. With preidentified candidate variables drawn from expert opinions and relevant literature, we will apply an interpretable machine learning–based AutoScore to develop 3 SERT scores. These 3 scores can be used at different times in the ED, that is, on arrival, during ED stay, and at admission. Furthermore, we will compare our novel SERT scores with established clinical scores and previously described black box machine learning models as baselines. Receiver operating characteristic analysis will be conducted on the testing cohorts for performance evaluation. Results The study is currently being conducted. The extracted data indicate approximately 1.8 million ED visits by over 810,000 unique patients. Modelling results are expected to be published in 2022. Conclusions The SERT scoring system proposed in this study will be unique and innovative because of its dynamic nature and modelling transparency. If successfully validated, our proposed solution will establish a standard for data processing and modelling by taking advantage of large-scale EHRs and interpretable machine learning tools. International Registered Report Identifier (IRRID) DERR1-10.2196/34201
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Haraguchi, Y. "(P1-47) Disaster Medicine and the Philosophy." Prehospital and Disaster Medicine 26, S1 (May 2011): s114. http://dx.doi.org/10.1017/s1049023x11003797.
Full textAbstract:
There are many problems, to be solved in the actual fields of disaster medicine. That is the reason why we completed the disaster medicine compendium, 2005. As the next stage, we focused upon the significance of the philosophy from the viewpoint of the disaster medicine.ResultsIn the disaster situation, leaders are obliged to determine the policies under the mental/ sophisticated consideration. Basically, the following famous phrase “the greatest good (happiness) for the greatest number of people” are accepted simply/childishly without profound thought. This phrase is presented by the popular concept of Utilitarianism beggined by Jeremy Bentham, followed by John Stuart Mill, etc. This concept strongly influenced in the field of disaster medicine, especially the decision making of triage. However, several argument or criticisms have been pointed out: i.e., definition of happiness, relief of the minority or so-called CWAP, etc. Other opinions are included, as follows: John Rawls: The Principle of Justice or Maximin Principle, Kan Naoto: Minimal unhappiness/misery in the society/people, etc.ConclusionsI basically appreciate the concept utilitarianism. But, especially, if we consider the CWAP or people in the poor countries under the actual unfavorable condition, the latter concepts should also be included.