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Simonson, Richard J., Joseph R. Keebler, Rosemarie Fernandez, Elizabeth H. Lazzara, and Alex Chaparro. "Over Triage: Injury Classification Mistake or Hindsight Bias?" Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 11, no. 1 (October 2022): 7–12. http://dx.doi.org/10.1177/2327857922111001.
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Patient triage is a critical stage in providing patients with the appropriate level of care required. Multiple metrics are considered in determining appropriate triage at the time of assessment. Due to the complexity of healthcare intervention, patients are often under- or over-triaged. Initiatives to reduce incorrect triages have been developed and implemented. These initiatives, however, may be based on hindsight bias and subsequently result in inaccurate assessments of triage accuracy and lead to improper triage-based education initiatives. This submission proposes the application of the SEIPS framework as a method of mitigating challenges introduced in the triage accuracy assessments due to this potential hindsight bias.
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Ure, Andrew. "Investigating the effectiveness of virtual treatment via telephone triage in a New Zealand general practice." Journal of Primary Health Care 14, no. 1 (March 3, 2022): 21–28. http://dx.doi.org/10.1071/hc21125.
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Introduction Telemedicine, including telephone triage, is increasingly being used in New Zealand general practices. Telephone triage involves diverting requests for same-day healthcare to a phone system where presenting complaints are explored only sufficiently to identify the most appropriate management pathway. Aim To assess the rates of repeat triage among general practice patients treated virtually via phone and compare these with outcomes for patients who were dealt with in person. Method 6 weeks of clinical telephone triage data were collected for Gore Medical Centre. Comparisons were made for patients treated virtually or in person, for whether complaints were a respiratory issue or not, and for whether their triage represented incomplete resolution of a previously triaged health complaint. To do this, patient notes for the 7 days prior to the phone triage were reviewed for medical consultations related to the same condition. Results Over 6 weeks, 455 telephone triages took place at the Gore Medical Centre: 133 triage phone calls resulted in 132 (29%) patients being treated virtually. Over the 6 study weeks, 19 virtually treated triage patients phoned again for further care of the same problem within 7 days (14%) while 23 patients (7%) who had been triaged to in person assessment also sought further care within 7 days. This difference was statistically significant (P < 0.05). There was no statistical difference in re-triage rates between Māori and non-Māori. Young age was a significant predictor for likelihood of re-triage. Discussion Virtual treatment via telephone triage at Gore Medical Centre resulted in a statistically increased likelihood of re-triage within 7 days compared with in person treatment. This raises questions about the efficacy of virtual treatment via telemedicine compared with in person treatment after triage.
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Huriani, Emil, Fitri Mailani, and Vebby Fitri Nur’arita. "The Role of Preceptor and Knowledge of Students on Triage Skills in The Emergency Unit." Jurnal Smart Keperawatan 9, no. 2 (December 20, 2022): 82. http://dx.doi.org/10.34310/jskp.v9i2.637.
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Nurse profession students are required to have skills in triage. So that when students do triage, there will be no over-triage and under-triage. This study aimed to determine the relationship between the preceptor role and knowledge of nursing profession students' perceptions of triage skills. This study was a descriptive-analytic study using a cross-sectional approach. The sampling technique used a consecutive sampling technique where the research was conducted for one month. The number of respondents in this study was 84 students of the nursing profession. Data were collected using instruments preceptor role questionnaire (PRQ), triage knowledge questionnaire (TKQ), and triage skill questionnaire (TSQ). Analysis of the research data showed that 58.3% of the students' preceptor roles were good, 53.6% had sufficient triage knowledge, and 58.3% of students perceived their triage skills to be good. There were significant correlations between the preceptor's role and expertise with the perception of triage skills of nursing profession students with a p-value <0.05. It is recommended to improve the knowledge and skills of professional nursing students through lectures on triage using a role-play or scenario learning system to enhance the knowledge and skills of triage students of the nursing profession.Keywords: triage skills; preceptor role; knowledgePeran Pembimbing dan Pengetahuan Terhadap Keterampilan Triase Mahasiswa di Instalasi Gawat DaruratABSTRAKMahasiswa program profesi ners dituntut untuk kompeten dalam melakukan keterampilan triase sehingga terhindar dari kesalahan dalam melakukan triase seperti over triage dan under triage. Tujuan penelitian ini adalah untuk mengidentifikasi hubungan peran preseptor dan pengetahuan dengan keterampilan triase pada mahasiswa program profesi ners. Desain penelitian adalah deskriptif analitik dengan pendekatan cross-sectional study. Jumlah sampel adalah 84 orang mahasiswa program profesi ners yang praktek di Instalasi Gawat Darurat salah satu rumah sakit di Kota Padang. Instrumen penelitian yang digunakan yaitu Preceptor Role Questionnaire (PRQ), Triage Knowledge Questionnaire (TKQ), dan Triage Skill Questionnaire (TSQ). Analisis statistik yang digunakan adalah uji Chi-square. Hasil penelitian menunjukkan bahwa peran preseptor baik (58,3%), pengetahuan triase cukup (53,6%), dan keterampilan triase mahasiswa baik (58,3%). Peran preseptor dan pengetahuan berhubungan dengan keterampilan triase mahasiswa program profesi ners dengan (p < 0,05). Disarankan agar institusi pendidikan menerapan metode pembelajaran role play atau skenario untuk perkuliahan mengenai triase agar dapat meningkatkan pengetahuan dan keterampilan triase mahasiswa program profesi ners. Kata Kunci: keterampilan triase, peran preseptor, pengetahuan
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Kumar, R., S. Bhoi, S. Chauhan, T. P. Sinha, G. Adhikari, G. Sharma, and K. Shyamla. "(A264) Does the Implementation of Start Triage Criteria in the Emergency Department Reduce Over- and under-Triage of Patients?" Prehospital and Disaster Medicine 26, S1 (May 2011): s72—s73. http://dx.doi.org/10.1017/s1049023x11002482.
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BackgroundAppropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.MethodsThe study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.ResultsOf 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.ConclusionsThe START triage criteria reduce over- and under-triage of patients.
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Astuti, Zulmah, Misbah Nurjannah, and Dwi Widyastuti. "Studi Fenomenologi:Peran perawat Dalam Penetapan Level Triase." Care : Jurnal Ilmiah Ilmu Kesehatan 6, no. 2 (July 2, 2018): 131. http://dx.doi.org/10.33366/cr.v6i2.887.
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Triase adalah proses pengumpulan informasi dari pasien, mengkategorikan dan memprioritaskan kondisi pasien dan merupakan bagian dari upaya manajemen patient safety di rumah sakit khususnya di Instalasi gawat darurat. Model triase yang banyak di gunakan di Dunia termasuk di Indonesia adalah triase lima level yang menempatkan pasien pada lima prioritas yaitu Resucitation, Emergent, Urgent, Nonurgent, Referred. Triase secara otonomi dilakukan oleh perawat yang teregistrasi dan telah mengikuti pelatihan khusus triase. di Indonesia, triase lima level telah digunakan di Rumah sakit umum dan evaluasi terkait pelaksanaannya masih belum banyak terpublikasi. Peran perawat dalam proses triase termasuk hal yang baru dan memerlukan pegkajian lebih mendalam terkait pengalaman perawat terhadap penetapan level triase. Penelitian kuaitatif fenomenologi desktriptif dilakukan pada enam partisipan yang merupakan perawat instalasi gawat darurat yang bekerja di ruang Triase, wawancara mendalam dilakukan dan hasil wawancara di transkrip dan dinalisis menggunakan metode Miles and Huberman (1994). Hasil penelitian didapatkan tiga tema besar yaitu level triase berdasarkan pengkajian primer, perawat belum mandiri, kolaborasi dokter dan perawat. Pelaksanaan triase belum menjadi tindakan mandiri perawat dan merupakan bagian dari tim triase dimana keputusan triase masih bergantung pada dokter. Diperlukan penelitian lebih lanjut terkait efisiensi dan efektifitas pelaksanaan triase oleh perawat di intalasi gawat darurat
Abstract
Triage is the process of collecting information from patients, categorizing and prioritizing the patient's condition and is part of patient safety management efforts in hospitals, especially in emergency departments. The triage model widely used in the World including Indonesia is a five-level triage that places patients on five priorities: Resucitation, Emergent, Urgent, Nonurgent, Referred. Triage is autonomously performed by registered nurses and has attended special triage training. In Indonesia, a triage of five levels has been used in public hospitals and evaluations related to their implementation have not been widely publicized. The role of nurses in the triage process is novel and requires a more in-depth review of nurses' experience of establishing triage levels. A qualitative study of descriptive phenomenology was performed on six participants who were nurses who worked in the Triage room. Research was conducted by conducting in-depth interviews and the results were analyzed using Miles and hubermen (1997). The research results obtained three major themes namely the level of triage based on the primary assessment, nurses have not been independent, collaboration of doctors and nurses. Implementation of triage has not been a self-sustaining act of nurses and is part of the triage team where triage decisions are still dependent on physicians. Further research is needed regarding the efficiency and effectiveness of triage implementation by nurses in emergency department
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Styrwoldt, E. "(P1-37) Over and Undertriage in Simulation Exercises." Prehospital and Disaster Medicine 26, S1 (May 2011): s110. http://dx.doi.org/10.1017/s1049023x11003694.
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Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.Material and Method76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.ResultsOf the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.ConclusionsTriage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.
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Minggawati, Zustantria Agustin, Achmad Faried, and Ayu Prawesti Priambodo. "Perbandingan Metode Triase Modifikasi Empat Tingkat Dengan Triase Lima Tingkat Emergency Severity Index (ESI) Berdasarkan Tingkat Akurasi di RSUD Cibabat." Jurnal Kesehatan Aeromedika 4, no. 2 (September 30, 2018): 71–75. http://dx.doi.org/10.58550/jka.v4i2.61.
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Keputusan triase harus tepat, akurat dan cepat karena akan mengancam keselamatan pasien. Sistem triase saat ini berbeda-beda. Sistem triase yang dianjurkan yaitu triase lima tingkat Emergency Severity Index (ESI) yang lebih akurat, mudah dipahami, mudah diaplikasi, mengurangi subjektifitas, dan sederhana dalam penggunaanya. RSUD Cibabat menggunakan triase empat tingkat modifikasi ATS yang belum dievaluasi tingkat keakuratannya. Tujuan penelitian ini yaitu mengetahui perbandingan metode triase empat tingkat modifikasi ATS dan metode triase lima tingkat ESI berdasarkan tingkat akurasi. Triase merupakan pemilahan, pengelompokkan pasien berdasarkan tingkat kegawatannya. Design penelitian yaitu cross over quasi eksperimental dengan 38 kegiatan triase baik kelompok kontrol dan kelompok intervensi dan 15 perawat yang melakukannya. Hasil penelitian menunjukkan bahwa triase ESI kategori expected triage 76,3%, under triase 13,2%, over triage 10,5%. Pada triase empat tingkat modifikasi ATS, expected triage 73,7 %, under triase 18,4%, over triage 7,9%. Hasil uji statistik, triase empat tingkat modifikasi ATS dengan triase lima tingkat ESI tidak terdapat perbedaan tingkat akurasi yang signifikan dengan nilai p-0,488. Namun jika ditelaah lebih lanjut ESI lebih akurat dalam memberikan keputusan expected triage. Adapun saran diberikan kepada RSUD Cibabat, dapat menggunakan triase ESI sebagai alternatif pilihan pengkajian triase karena akurat, sederhana, mudah digunakan.
Kata Kunci : , ,
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Atmojo, Joko Tri, Aris Widiyanto, and Tri Yuniarti. "RELIABILITAS SISTEM TRIASE DALAM PELAYANAN GAWAT DARURAT : A REVIEW." Intan Husada Jurnal Ilmu Keperawatan 7, no. 2 (July 12, 2019): 23–31. http://dx.doi.org/10.52236/ih.v7i2.148.
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Pendahuluan.Triase dalam pelayanan gawat darurat adalah proses pengambilan keputusan yang diterapkan untuk mengidentifikasi pasien dan mengoptimalkan sumber daya. Sejak 1990 hingga tahun 2000 telah dirancang triase 5 skala diantaranya: Australian Triage Scale (ATS), Canadian Emergency Department Triage and Acuity Scale (CTAS), Manchester Triage Scale (MTS), dan Emergency Severity Index (ESI). Sehingga timbul pertanyaan tentang keandalan skala triase (reliabilitas). Pada review kali ini penulis akan fokus pada berbagai macam skala triase, penggunaannya di beberapa negara, dan reliabilitasnya. Penulis tidak akan menulis kembali pedoman/guideline dari triase yang telah secara resmi terpublikasikan.
Metode. Penelusuran ini dilakukan mulai dari Januari hingga Maret 2019 dengan melakukan penelusuran database: PubMed, EMBASE, dan CINAHL. Kata kunci yang digunakan: ‘Triage in emergency 'ATAU' Canadian Triage and Acuity Scale’ ATAU ‘Emergency Severity Index’ ATAU ‘Manchester Triage Scale’ ATAU ‘Australasian Triage Scale’. Kriteria inklusi: uji acak terkendali (randomized controlled tria), studi retrospektif, observasional, studi kasus, review, systematc review, dan meta analisis. Hasil akhir review menemukan 12 artikel yang sesuai
Hasil. Uji statistik Kappa menunjukan reliabilitas ATS 0,428 (95% CI 0,340-0,509), reliabilitas CTAS 0,871 (95% CI (0,840-0,897), reliabilitas ESI 0.730 (95% CI : 0.692 hingga 0.767), reliabilitas MTS 0,751 (CI 95%: 0,677 hingga 0,810).
Kesimpulan. Berdasarkan hasil reliabilitas nilai ATS menunjukan realibilitas terkecil, realibilitas CTAS merupakan yang tertinggi, namun memiliki keterbatasan pada pelaksaan diluar Kanada. MTS merupakan skala yang reliabilitas dan juga penerapannya dianggap yang paling baik.
Kata Kuci: Reliabilitas, Canadian Triage and Acuity Scale (CTAAS), Emergency Severity Index (ESI), Manchester Triage Scale (MTS), Australasian Triage Scale (ATS).
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Hilmi, L. M., A. Heerboth, D. Anthony, C. Tedeschi, and S. Balsari. "(A167) Patient Tracking In Disaster Drills." Prehospital and Disaster Medicine 26, S1 (May 2011): s48. http://dx.doi.org/10.1017/s1049023x11001658.
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IntroductionDisaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.MethodsOver eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.ResultsThere was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.ConclusionsOur group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
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McCourt, Jacita A., Eli Strait, and Jeanne Lee. "583 Photos of Burn Wounds Can Help Reduce Over-Triage and Prevent Unnecessary Ambulance Transfer." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S128—S129. http://dx.doi.org/10.1093/jbcr/irac012.211.
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Abstract Introduction Burn wounds can be difficult to assess for providers outside the burn center and can result in over triage. The combination of photos of burn wounds with a clinical history can help burn practitioners make appropriate triage decisions, including immediate ambulance transfer vs scheduling an outpatient follow up appointment. Appropriate photo triage can help reduce healthcare costs by eliminating both unnecessary transfers to the burn center and overburdening burn resources. This performance improvement project involved the development of a secure photo sharing web portal and photo triage clinical pathway to help burn practitioners appropriately triage burn patients being evaluated at health care facilities within the catchment area of an American Burn Association verified adult and pediatric burn center. Methods Existing technology was used to develop a burn photo sharing web portal that can be easily accessed by providers outside the burn center. A new clinical pathway for burn photo triage was developed. Education was formulated for nurses and providers within the burn center and for referring facilities. Retrospective data was collected for the 4 years of ambulance transfers captured in the outpatient burn registry prior to the implementation of the photo triage clinical pathway. Comparison data was also abstracted for the first year after implementation. Patients were categorized as over triaged or appropriately triage based on the first set of photos captured in the EMR. Results In the pre-triage years there were a total of 242 ambulance transfers to the outpatient burn clinic. 150 (62%) of those patients were appropriately triaged, while 92 (38%) were over triaged. In the year following implementation there were 27 ambulance transfers to the outpatient burn clinic. 25 (92.6%) of these patients were appropriately triaged while 2 (7.4%) were over triaged. Overall ambulance transfers to the outpatient burn clinic dropped by more than 50% (average of 60.5 transfer per year down to 27 after implementation). Conclusions Patients with burn injuries at referring facilities were more appropriately triaged when using photos of wounds which ultimately reduced the number of unnecessary ambulance transfers.
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Cicero, Mark X., Barbara Walsh, Yauheni Solad, Travis Whitfill, Geno Paesano, Kristin Kim, Carl R. Baum, and David C. Cone. "Do You See What I See? Insights from Using Google Glass for Disaster Telemedicine Triage." Prehospital and Disaster Medicine 30, no. 1 (January 9, 2015): 4–8. http://dx.doi.org/10.1017/s1049023x1400140x.
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AbstractIntroductionDisasters are high-stakes, low-frequency events. Telemedicine may offer a useful adjunct for paramedics performing disaster triage. The objective of this study was to determine the feasibility of telemedicine in disaster triage, and to determine whether telemedicine has an effect on the accuracy of triage or the time needed to perform triage.MethodsThis is a feasibility study in which an intervention team of two paramedics used the mobile device Google Glass (Google Inc; Mountain View, California USA) to communicate with an off-site physician disaster expert. The paramedic team triaged simulated disaster victims at the triennial drill of a commercial airport. The simulated victims had preassigned expected triage levels. The physician had an audio-video interface with the paramedic team and was able to observe the victims remotely. A control team of two paramedics performed disaster triage in the usual fashion. Both teams used the SMART Triage System (TSG Associates LLP; Halifax, England), which assigns patients into Red, Yellow, Green, and Black triage categories. The paramedics were video recorded, and their time required to triage was logged. It was determined whether the intervention team and the control team varied regarding accuracy of triage. Finally, the amount of time the intervention team needed to triage patients when telemedicine was used was compared to when that team did not use telemedicine.ResultsThe two teams triaged the same 20 patients. There was no significant difference between the two groups in overall triage accuracy (85.7% for the intervention group vs 75.9% for the control group; P = .39). Two patients were triaged with telemedicine. For the intervention group, there was a significant difference in time to triage patients with telemedicine versus those without telemedicine (35.5 seconds; 95% CI, 72.5-143.5 vs 18.5 seconds; 95% CI, 13.4-23.6; P = .041).ConclusionThere was no increase in triage accuracy when paramedics evaluating disaster victims used telemedicine, and telemedicine required more time than conventional triage. There are a number of obstacles to available technology that, if overcome, might improve the utility of telemedicine in disaster response.CiceroMX, WalshB, SoladY, WhitfillT, PaesanoG, KimK, BaumCR, ConeDC. Do you see what I see? Insights from using Google Glass for disaster telemedicine triage. Prehosp Disaster Med. 2015;30(1):1-5.
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Lya Fitriyani, Saldy Yusuf, and Kusrini S. Kadar. "SISTEM TRIASE ONLINE DALAM PERAWATAN LUKA SELAMA PANDEMI COVID-19: LITERATUR REVIEW." Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing) 8, no. 4 (October 31, 2022): 628–41. http://dx.doi.org/10.33023/jikep.v8i4.1210.
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ABSTRAK
Pendahuluan: Perawatan luka adalah aspek penting yang harus terus dilakukan selama COVID-19. Solusi yang bisa dilakukan adalah Triage. Triase dalam perawatan luka bertujuan menentukan tingkat kedaruratan luka sebagai langkah awal pengambilan keputusan klinis. Tinjauan pustaka ini bertujuan untuk mengkaji penerapan sistem triase online dalam perawatan luka selama COVID-19. Metode: Tinjauan Literatur ini dilakukan dengan mencari artikel di database PubMed, ProQuest, Cochrane Library. Hasil: Sembilan penelitian termasuk kriteria inklusi. Sebuah studi menunjukkan bahwa triase online memiliki dampak positif pada penyembuhan luka 78,4% jika dibandingkan dengan kunjungan langsung 76,0% (p = 0,318). Penggunaan triase berdasarkan jenis luka dan penyakit penyerta pada Ulkus Kaki Diabetik menunjukkan hasil yang positif bahwa 41 (31,8%) pasien sembuh, 3 (1,9%) mengalami amputasi berat, 3 (1,9%) meninggal, 1 (0,7%) positif COVID-19. Indikator yang digunakan sebagai acuan dalam triase adalah pemeriksaan suhu tubuh, CT-Scan dada, pemeriksaan darah, usap nasofaring, penyakit penyerta, dan gambaran luka. Selain itu, empat penelitian menunjukkan beberapa penggunaan media online yang dapat memfasilitasi triase antara lain WhatsApp, mHealth, telehealth. Diskusi: Sistem triase online dapat diterapkan melalui berbagai cara antara lain mengirim foto atau video, melalui pesan teks, video call. penerapan triase luka dapat meminimalkan risiko kontaminasi dengan area berisiko tinggi COVID-19.
Kata kunci: COVID-19, Perawatan Luka, Triase Online,
ABSTRACT
Background: Wound care is important aspect that must be continue during COVID-19. One solution that can be done is Triage. This literature review aims to examine the application of online triage systems in wound care during COVID-19. Method: Current Literature review was conducted by searching for articles in the PubMed, ProQuest, and Cochrane Library databases. Result: Nine studies including of inclusion criteria. One study confirmed that online triage had a positive impact on wound healing 78.4% when compared to in-person visits 76.0% (p = 0.318). Use of triage based on the type of wound and comorbidities on Diabetic Foot Ulcer showed a positive result, 41 (31.8%) patients recovered, 3 (1.9%) had major amputations, 3 (1.9%) died, 1 (0.7%) positive for COVID-19. Indicators used as a reference in triage are body temperature checks, chest CT-Scan, blood tests, nasopharyngeal swabs, comorbid diseases, and wound features. In addition, four studies report various platform, including; WhatsApp, mHealth, and Telehealth. Discussion: the online triage system can be applied through various methods including sending photos or videos, via text messages, video calls. The application of wound triage can minimize the risk of contamination with highrisk areas COVID-19.
Keyword: COVID-19, Online Triage, Wound Care
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Graversen, Dennis Schou, Linda Huibers, Morten Bondo Christensen, Flemming Bro, Helle Collatz Christensen, Claus Høstrup Vestergaard, and Anette Fischer Pedersen. "Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark." BMJ Open 10, no. 3 (March 2020): e033528. http://dx.doi.org/10.1136/bmjopen-2019-033528.
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ObjectivesTo compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage.DesignNatural quasi-experimental cross-sectional study.SettingTwo Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.Participants1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441).Main outcome measuresTwenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call.ResultsThe risk ofpoorquality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding ‘allowing the caller to describe the situation’ (GP: 13.5% nurse: 9.8%), ‘mastering questioning techniques’ (GP: 27.4% nurse: 21.1%), ‘summarising’ (GP: 33.0% nurse: 21.0%) and ‘paying attention to caller’s experience’ (GP: 25.7% nurse: 17.0%). The risk ofpoorquality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items.ConclusionsCompared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.
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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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Peng, Yang, and Hai Hu. "Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study." BMJ Open 11, no. 10 (October 2021): e051802. http://dx.doi.org/10.1136/bmjopen-2021-051802.
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ObjectiveThe use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.DesignData in the Huaxi Earthquake Casualty Database were analysed retrospectively.SettingThis study was conducted in China.ParticipantsData on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.Primary outcome measureThe receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.ResultsThe ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.ConclusionAll methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.
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Poon, Wai Kwong. "TRIAGE! TRIAGE!! TRIAGE!!! (NOT TREATMENT!!)." Prehospital and Disaster Medicine 14, S1 (March 1999): S96—S97. http://dx.doi.org/10.1017/s1049023x0003497x.
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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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Khorram- Manesh, A., A. Hedelin, and P. Ortenwall. "(A82) Triage in the Prehospital Setting." Prehospital and Disaster Medicine 26, S1 (May 2011): s23. http://dx.doi.org/10.1017/s1049023x11000872.
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IntroductionThe prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.AimThe aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.Method and MaterialOver 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.ResultsThere was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.Discussion and ConclusionsA mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
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Zhang, David, Bradley Shy, and Nicholas Genes. "Early Rooming Triage: Accuracy and Demographic Factors Associated with Clinical Acuity." Western Journal of Emergency Medicine 23, no. 2 (February 28, 2022): 145–51. http://dx.doi.org/10.5811/westjem.2021.12.53873.
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Introduction: Early rooming triage increases patient throughput and satisfaction by rapidly assigning patients to a definitive care area, without using vital signs or detailed chart review. Despite these operational benefits, the clinical accuracy of early rooming triage is not well known. We sought to measure the accuracy of early rooming triage and uncover additional patient characteristics that can assist triage. Methods: We conducted a single-center, retrospective population study of walk-in emergency department (ED) patients presenting to the ED via an early rooming triage system, examining triage accuracy and demographic factor correlation with higher acuity ED outcomes. Results: Among all patients included from the three-year study period (N = 238,457), early rooming triage was highly sensitive (0.89) and less specific (0.61) for predicting which patients would have a severe outcome in the ED. Patients triaged to the lowest acuity area of the ED experienced severe outcomes in 4.39% of cases, while patients triaged to the highest acuity area of the ED experienced severe outcomes in 65.9% of cases. An age of greater than 43 years (odds ratio [OR] 3.48, 95% confidence interval: 3.40, 3.57) or patient’s home address farther from the ED ([OR] 2.23 to 3.08) were highly correlated with severe outcomes. Multivariable models incorporating triage team judgment were robust for predicting severe outcomes at triage, with an area under the receiver operating characteristic of 0.82. Conclusion: Early rooming workflows are appropriately sensitive for ED triage. Consideration of demographic factors, automated or otherwise, can augment ED processes to provide optimal triage.
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Irawan, Deni, Woro Hapsari, and Yohan Tedy Kurniawan. "EFEK TRIAGE EMERGENCY SEVERITY INDEX (ESI) TERHADAP LENGTH OF STAY DI INSTALASI GAWAT DARURAT RSU ISLAM HARAPAN ANDA KOTA TEGAL." JURNAL PENELITIAN KEPERAWATAN 6, no. 1 (May 11, 2020): 20–27. http://dx.doi.org/10.32660/jpk.v6i1.447.
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Kepadatan pasien menjadi masalah serius yang terjadi di unit gawat darurat dan menyebabkan efek negatif dari peningkatan kematian pasien, ketidakpuasan dengan layanan gawat darurat, kelelahan perawat, peningkatan risiko tertular penyakit menular, dan peningkatan lama tinggal. Length of Stay (LOS) berkepanjangan terkait erat dengan kinerja layanan keperawatan dan triase kualitas di ruang gawat darurat. Metode triase rumah sakit saat ini telah berevolusi, sistem triase cepat dan efisien telah terbukti mengurangi kepadatan pasien dan lama tinggal. Emergency Severity Index (ESI) adalah sistem triase yang valid dan akurat dengan mengidentifikasi pasien secara cepat yang membutuhkan perhatian segera. Tujuan dari penelitian ini adalah untuk mengukur "Triage Emergency Severity Index (ESI) Efek pada Durasi Menginap di Departemen Darurat". Penelitian ini adalah penelitian Quasi Eksperimen Desain menggunakan Post Test Only Non-equivalent Control Group Design, teknik purposive sampling. Jumlah sampel dalam penelitian ini adalah 110 responden yang dibagi ke dalam kelompok perlakuan menggunakan triage Emergency Severity Index (ESI) sebanyak 55 responden dan kelompok kontrol menggunakan responden Triage klasik 55. Hasil analisis Uji Mann Whitney, nilai p 0,000 <0,05. Kesimpulan Ada pengaruh penerapan Triage Emergency Severity Index (ESI) terhadap Lama tinggal di ED. Triage Emergency Severity Index sebagai alat untuk menyortir pasien ini lebih efektif digunakan.
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Tanner, Richard, Eugene Cassidy, and Iomhar O’Sullivan. "Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm." Advances in Emergency Medicine 2014 (September 3, 2014): 1–9. http://dx.doi.org/10.1155/2014/492102.
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Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses (n=49) were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, P<0.001. The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, P<0.001).
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Cuttance, Glen, Kathryn Dansie, and Tim Rayner. "Paramedic Application of a Triage Sieve: A Paper-Based Exercise." Prehospital and Disaster Medicine 32, no. 1 (December 14, 2016): 3–13. http://dx.doi.org/10.1017/s1049023x16001163.
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AbstractIntroductionTriage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area.ObjectiveThe goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates.MethodTwo hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire.ResultsThe study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups.ConclusionThis study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A “just-in-time” educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI.CuttanceG, DansieK, RaynerT. Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3–13.
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Neal, Daniel J., Joseph A. Barbera, and John R. Harrald. "-PLUS Prehospital Mass-Casualty Triage: A Strategy for Addressing Unusual Injury Mechanisms." Prehospital and Disaster Medicine 25, no. 3 (June 2010): 227–36. http://dx.doi.org/10.1017/s1049023x00008086.
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AbstractIntroduction:Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of “minor” or “moderate” patients may be delayed.Hypothesis:When rapid initial triage protocols are utilized, a significant triage deficiency (“under-triage”) may occur when “minor” or “moderate” casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize “delayed transport” casualties based upon signs and symptoms related to their MOI.Methods:Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to “minor” and “moderate” cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process.Results:Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym “-PLUS”.Conclusions:“-PLUS” Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. “-PLUS” also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required.
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Arshad, Faizan H., Alan Williams, Glenn Asaeda, Douglas Isaacs, Bradley Kaufman, David Ben-Eli, Dario Gonzalez, et al. "A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department." Prehospital and Disaster Medicine 30, no. 2 (February 17, 2015): 199–204. http://dx.doi.org/10.1017/s1049023x14001447.
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AbstractIntroductionThe objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise.MethodsA computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system.ResultsOverall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2).ConclusionsThe FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.ArshadFH, WilliamsA, AsaedaG, IsaacsD, KaufmanB, Ben-EliD, GonzalezD, FreeseJP, HillgardnerJ, WeakleyJ, HallCB, WebberMP, PrezantDJ. A modified Simple Triage and Rapid Treatment algorithm from the New York City (USA) Fire Department. Prehosp Disaster Med. 2015;30(2):1-6.
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Lee, Christopher W. C., Shelley L. McLeod, Kristine Van Aarsen, Michelle Klingel, Jeffrey M. Franc, and Michael B. Peddle. "First Responder Accuracy Using SALT during Mass-casualty Incident Simulation." Prehospital and Disaster Medicine 31, no. 2 (February 9, 2016): 150–54. http://dx.doi.org/10.1017/s1049023x16000091.
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AbstractIntroductionDuring mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.HypothesisTriage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.MethodsAll students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.ResultsThirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).ConclusionsPrimary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.LeeCWC, McLeodSL, Van AarsenK, KlingelM, FrancJM, PeddleMB. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150–154.
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Betz, Martin, James Stempien, Sachin Trevidi, and Rhonda Bryce. "A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations." CJEM 19, no. 04 (December 5, 2016): 265–70. http://dx.doi.org/10.1017/cem.2016.398.
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ABSTRACT Objectives Emergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS). Methods This observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged. Participants’ CTAS scores were collected from the electronic record. Patients arriving to the ED by ambulance were excluded. Results A total of 536 participants were timed over 13 separate intervals. Of these, 11 left without being triaged. Participants who scored either CTAS 1 or 2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1) minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6, 24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, and CTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patients subsequently categorized as CTAS 1 or 2, 20.8% waited longer than the recommended time-to-physician of 15 minutes to be triaged. Conclusions All urban EDs closely follow patients’ wait times, often stratified according to triage category, which are assumed to be time-stamped upon a patient’s arrival in the ED. We note that pre-triage times exceed the CTAS recommended time-to-physician in a possibly significant proportion of patients. EDs should consider documenting times to treatment from the moment of patient arrival rather than registration.
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Bajka, Anahita, Maximilian Robert Justus Wiest, Timothy Hamann, Mario Damiano Toro, and Sandrine Anne Zweifel. "Assessment of Patients’ Confidence Regarding a New Triage Concept in a Medical Retina Clinic during the First COVID-19 Outbreak." International Journal of Environmental Research and Public Health 18, no. 11 (May 29, 2021): 5846. http://dx.doi.org/10.3390/ijerph18115846.
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Background: During the first COVID-19 pandemic outbreak, a new triage concept had to be implemented for patients with retinal diseases having a scheduled appointment at the medical retina clinic. In this study, we aimed to assess patients’ confidence in this triage concept and patients’ satisfaction regarding the received treatment during the outbreak. Methods: This retrospective study included all patients with a diagnosed retinal disease, triaged into three priority groups based on their condition’s urgency during lockdown. After restrictions were eased, a subset of previously triaged patients was interviewed to assess their confidence in the triage and their satisfaction regarding the received treatment during the pandemic. Results: In total, 743 patients were triaged during the lockdown. Over 80% received an urgent appointment (priority 1). Among all priority 1 patients, over 84% attended their appointment and 77% received an intravitreal injection (IVI), while 7% cancelled their appointment due to COVID-19. In post-lockdown interviews of 254 patients, 90% trusted the emergency regimen and received treatment. Conclusions: Our triage seemed to be useful in optimizing access to treatment for patients with retinal diseases. An excellent rating of patients’ confidence in the triage and satisfaction regarding the received treatment during the first COVID-19 outbreak could be achieved.
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Ouellet, Simon, Guy Bélanger, and Mélanie Bérubé. "Interrater Reliability of a Tool Measuring the Quality of Nursing Triage in the Emergency Department." Science of Nursing and Health Practices 4, no. 2 (February 16, 2022): 86–100. http://dx.doi.org/10.7202/1086403ar.
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Introduction: Triage plays an essential role in the Emergency Department (ED), helping maintain a safe patient flow. Although assessing the quality of the triage process is crucial, to date, there has been no metrological testing of a tool measuring the quality of nursing triage. Objective: This study aimed to assess the interrater reliability of the Audit Triage Tool (ATT) in Quebec, Canada. Methods: This retrospective cohort study took place in a regional ED. Fifty triages were selected using a systematic random sampling technique with quotas of 10 triages grouped under 5 chief complaints: chest pain, abdominal pain, neurological problems, major blunt trauma and fever. A total of 4 auditors individually applied the 49 criteria of the ATT to 50 triages. The interrater reliability was measured with the intraclass correlation coefficient (ICC), percentage of unanimity (PU) and percentage of agreement (PA). Results: Based on the ICC, 33/49 criteria showed fair (ICC 0.60, comparatively to only 2/26 implicit criteria. Discussion and conclusion: Findings showed that a quarter of the ATT criteria had poor interrater reliability according to various statistical tests. Solutions to improve the reliability of the ATT, mostly regarding the implicit criteria, are needed. Finally, future methodological research on triage quality assessment should focus on a thorough validation of the ATT.
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Knotts, Kristina E., Stuart Etengoff, Kimberly Barber, and Ina J. Golden. "Casualty Collection in Mass-Casualty Incidents: A Better Method for Finding Proverbial Needles in a Haystack." Prehospital and Disaster Medicine 21, no. 6 (December 2006): 459–64. http://dx.doi.org/10.1017/s1049023x00004209.
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AbstractIntroduction:Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care.Objective:The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags.Methods:Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared.Results:Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks.Conclusions:The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.
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Meer, Elana A., Maguire Herriman, Doreen Lam, Andrew Parambath, Roy Rosin, Kevin G. Volpp, Krisda H. Chaiyachati, and John D. McGreevey. "Design, Implementation, and Validation of an Automated, Algorithmic COVID-19 Triage Tool." Applied Clinical Informatics 12, no. 05 (October 2021): 1021–28. http://dx.doi.org/10.1055/s-0041-1736627.
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Abstract Objective We describe the design, implementation, and validation of an online, publicly available tool to algorithmically triage patients experiencing severe acute respiratory syndrome coronavirus (SARS-CoV-2)-like symptoms. Methods We conducted a chart review of patients who completed the triage tool and subsequently contacted our institution's phone triage hotline to assess tool- and clinician-assigned triage codes, patient demographics, SARS-CoV-2 (COVID-19) test data, and health care utilization in the 30 days post-encounter. We calculated the percentage of concordance between tool- and clinician-assigned triage categories, down-triage (clinician assigning a less severe category than the triage tool), and up-triage (clinician assigning a more severe category than the triage tool) instances. Results From May 4, 2020 through January 31, 2021, the triage tool was completed 30,321 times by 20,930 unique patients. Of those 30,321 triage tool completions, 51.7% were assessed by the triage tool to be asymptomatic, 15.6% low severity, 21.7% moderate severity, and 11.0% high severity. The concordance rate, where the triage tool and clinician assigned the same clinical severity, was 29.2%. The down-triage rate was 70.1%. Only six patients were up-triaged by the clinician. 72.1% received a COVID-19 test administered by our health care system within 14 days of their encounter, with a positivity rate of 14.7%. Conclusion The design, pilot, and validation analysis in this study show that this COVID-19 triage tool can safely triage patients when compared with clinician triage personnel. This work may signal opportunities for automated triage of patients for conditions beyond COVID-19 to improve patient experience by enabling self-service, on-demand, 24/7 triage access.
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Lin, Daren, and Andrew Worster. "Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale." CJEM 15, no. 06 (November 2013): 353–58. http://dx.doi.org/10.2310/8000.2013.130842.
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ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (κ) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.Results:Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was κ −0.9, (95% confidence interval [CI] 20.96 to 20.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.
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Stackhouse, S., G. Innes, and E. Grafstein. "LO62: Variability in triage performance for chest pain patients in two Canadian cities." CJEM 20, S1 (May 2018): S28—S29. http://dx.doi.org/10.1017/cem.2018.124.
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Introduction: CTAS triage acuity determinations are used to prioritize patients, describe illness acuity, and compare casemix across institutions. The latter functions assume reliable application in diverse settings, but no studies have evaluated this using actual triage data. Methods: This administrative database study included all patients with a triage complaint of chest pain (CP) in Vancouver (2012-16) and Calgary (2016). We stratified patients into high vs. non-high severity groups based on discharge diagnoses. High severity diagnoses included all patients with aortic pathology, ACS, shock or arrest states, as well as patients requiring admission because of pulmonary embolism, dysrhythmias, CHF, neurologic or respiratory conditions. We dichotomized patient triage assignments to high (CTAS 1,2) vs. low (3,4,5) acuity, then constructed 2x2 tables correlating CTAS acuity with disease severity. Main outcomes included the proportion of CP patients triaged to high acuity categories and CTAS sensitivity for high severity conditions. Results: We studied 97277 Vancouver and 18622 Calgary patients. Age (mean, 54.8 years), sex (53.5% male) and casemix distributions were similar between cities, although Calgary had more high severity conditions (15.0% v. 10.5%) and a higher admission rate (22.5% v. 21.4%). Calgary triage nurses placed more patients in high acuity triage categories (85.1% vs. 45.2%) and achieved higher sensitivity for severe illness (96.2% vs. 76.2%); however, they were less accurate (28.7% vs. 60.3%) and less specific (16.8% vs. 58.4%). The proportion of CP patients triaged into high acuity categories ranged from 79% to 87% across four Calgary hospitals and from 28% to 62% at five Vancouver hospitals. Conclusion: This study shows profoundly different triage categorization at different sites seeing similar patient populations. Triage nurses are taught to strive for high sensitivity, but there may be operational consequences if specificity drops too low and large numbers of non-severe patients are triaged into high acuity categories. It is not clear which approach is better but these data suggest CTAS should not be used to compare patient acuity or complexity across different hospitals or regions.
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Badiali, Stefano, Aimone Giugni, and Lucia Marcis. "Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?" Disaster Medicine and Public Health Preparedness 11, no. 3 (January 9, 2017): 305–9. http://dx.doi.org/10.1017/dmp.2016.151.
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AbstractObjectiveSTART (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether “last-minute” START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.MethodsIn this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher’s exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.ResultsThe START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 “preventable deaths” on 6000 cases because of incorrect triage, whereas the START group had 91.ConclusionsEven a “last-minute” training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305–309)
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Khursheed, M., K. Ejaz, and F. Hanif. "(A261) Evolution of Triage Services in the Emergency Department Aga Khan University Hospital- Karachi." Prehospital and Disaster Medicine 26, S1 (May 2011): s72. http://dx.doi.org/10.1017/s1049023x11002457.
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The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.
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Brutschin, Vanessa, Monika Kogej, Sylvia Schacher, Moritz Berger, and Ingo Gräff. "The presentational flow chart “unwell adult” of the Manchester Triage System—Curse or blessing?" PLOS ONE 16, no. 6 (June 3, 2021): e0252730. http://dx.doi.org/10.1371/journal.pone.0252730.
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Background The presentational flow chart “unwell adult” of the Manchester Triage System (MTS) occupies a special role in this triage system, defined as the nonspecific presentation of an emergency patient. Current scientific studies show that a considerable proportion of emergency room patients present with so-called "nonspecific complaints". The aim of the present study is to investigate in detail the initial assessment of emergency patients triaged according to the presentational flow chart "unwell adult". Methods Monocentric, retrospective observational study. Results Data on 14,636 emergency department visits between March 12th and August 12th, 2019 were included. During the observation period, the presentational flow chart "unwell adult" was used 1,143 times and it was the third most frequently used presentational flow chart. Patients triaged with this flow chart often had unspecific complaints upon admission to the emergency department. Patients triaged with the “unwell adult” chart were often classified with a lower triage level. Notably, patients who died in hospital during the observation period frequently received low triage levels. The AUC for the MTS flow chart “unwell adult” and hospitalization in general for older patients (age ≥ 65 years) was 0.639 (95% CI 0.578–0.701), and 0.730 (95% CI 0.714–0.746) in patients triaged with more specific charts. The AUC for the MTS flow chart “unwell adult” and admission to ICU for older patients (age ≥65 years) was 0.631 (95% CI 0.547–0.715) and 0.807 (95% CI 0.790–0.824) for patients triaged with more specific flow charts. Comparison of the predictive ability of the MTS for in-hospital mortality in the group triaged with the presentational flow chart “unwell adult” revealed an AUC of 0.682 (95% CI 0.595–0.769) vs. 0.834 (95% CI 0.799–0.869) in the other presentational flow charts. Conclusion The presentational flow chart "unwell adult" is frequently used by triage nurses for initial assessment of patients. Patient characteristics assessed with the presentational flow chart "unwell adult" differ significantly from those assessed with MTS presentational flow charts for more specific symptoms. The quality of the initial assessment in terms of a well-functioning triage priority assessment tool is less accurate than the performance of the MTS described in the literature.
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Engan, Mette, Asle Hirth, and Håvard Trønnes. "Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department." International Journal of Pediatrics 2018 (October 15, 2018): 1–8. http://dx.doi.org/10.1155/2018/4676758.
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Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.
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Allen, Casey J., Daniel J. Baldor, Carl I. Schulman, Louis R. Pizano, Alan S. Livingstone, and Nicholas Namias. "Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients." American Surgeon 83, no. 6 (June 2017): 648–52. http://dx.doi.org/10.1177/000313481708300632.
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Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.
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Roque Mazoni, Simone, Juliane Andrade, Priscila da Silva Antonio, Solange Baraldi, Fernanda Leticia Frates Cauduro, Paulo Henrique Fernandes dos Santos, Pablo Ribeiro de Sousa, and Diana Lucia Moura Pinho. "Triage Strategies for COVID-19 Cases: A Scope Review." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 59 (January 2022): 004695802210958. http://dx.doi.org/10.1177/00469580221095824.
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In the midst of the pandemic caused by the new coronavirus (SARS-CoV-2), researchers and governmental and non-governmental institutions are mobilizing to implement strategies to face cases of COVID-19. Aim: This study aimed to map the triage strategies for cases of COVID-19, with the purpose of identifying sources in the literature that make it possible to explore the understanding of the strategies in different contexts. A scope review was conducted with searches in the CINAHL Database, PubMed, LILACS and hand-search, considering studies carried out with users of health services and documents published by governmental and non-governmental institutions, between the years 2019 and 2020, resulting in 40 articles for full reading. To explore the key concept, thematic analysis was carried out at two levels: (1) triage strategies, (2) forms and experiences of triage. Five triage strategies were mapped: health services triage; digital triage by remote use of technologies; community triage; home visit triage and airport and port triage. The forms and experiences of mapped triages involved risk classification, diagnosis and definition of conducts or combined. The use of strategies with remote technological resources stands out, as well as the adaptation of existing scales with simple algorithms as a tendency.
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Claudius, Ilene, Amy H. Kaji, Genevieve Santillanes, Mark X. Cicero, J. Joelle Donofrio, Marianne Gausche-Hill, Saranya Srinivasan, and Todd P. Chang. "Accuracy, Efficiency, and Inappropriate Actions Using JumpSTART Triage in MCI Simulations." Prehospital and Disaster Medicine 30, no. 5 (September 1, 2015): 457–60. http://dx.doi.org/10.1017/s1049023x15005002.
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AbstractIntroductionUsing the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) algorithm for the triage of pediatric patients in a mass-casualty incident (MCI) requires assessing the results of each step and determining whether to move to the next appropriate action. Inappropriate application can lead to performance of unnecessary actions or failure to perform necessary actions.Hypothesis/ProblemTo report overall accuracy and time required for triage, and to assess if the performance of unnecessary steps, or failure to perform required steps, in the triage algorithm was associated with inaccuracy of triage designation or increased time to reach a triage decision.MethodsMedical students participated in an MCI drill in which they triaged both live actors portraying patients and computer-based simulated patients to the four triage levels: minor, delayed, immediate, and expectant. Their performance was timed and compared to intended triage designations and a priori determined critical actions.ResultsThirty-three students completed 363 scenarios. The overall accuracy was 85.7% and overall mean time to assign a triage designation was 70.4 seconds, with decreasing times as triage acuity level decreased. In over one-half of cases, the student omitted at least one action and/or performed at least one action that was not required. Each unnecessary action increased time to triage by a mean of 8.4 seconds and each omitted action increased time to triage by a mean of 5.5 seconds.DiscussionIncreasing triage level, performance of inappropriate actions, and omission of recommended actions were all associated with increasing time to perform triage.ClaudiusI, KajiAH, SantillanesG, CiceroMX, DonofrioJJ, Gausche-HillM, SrinivasanS, ChangTP. Accuracy, efficiency, and inappropriate actions using JumpSTART triage in MCI simulations. Prehosp Disaster Med. 2015;30(5):457–460.
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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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Singer, Jonathan, and James E. Olson. "To Triage, To Triage." Academic Emergency Medicine 19, no. 9 (July 31, 2012): E1117. http://dx.doi.org/10.1111/j.1553-2712.2012.01421.x.
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Tavakoli, Nader, Saeed Abbasi, and Afrooz Tayebi. "Concordance of triage performed with emergency severity index in the emergency departments of Rasoul Akram and Haft Tir hospitals." Journal of Preventive Epidemiology 5, no. 1 (October 29, 2020): e11-e11. http://dx.doi.org/10.34172/jpe.2020.11.
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Introduction: Triage is prioritizing patients by disease severity in the shortest possible time. Proper triage increases the quality of patient care services, increases patient’s satisfaction, decreases patient waiting time, decreases mortality, and enhances emergency department efficiency. Objectives: The aim of this study was to evaluate the concordance of triage performed by nurses with ESI standard, at Rasoul Akram and Haft Tir hospitals, which are the most important educational centers of Iran University of Medical Sciences. Patients and Methods: This is a cross-sectional design study done in 2019. The study population is patients referred to Rasoul Akram and Haft Tir hospitals. A sample of 800 patients was selected. In this study, we determined how triage level were determined and compared with triaging by emergency medicine assistant. Data were analyzed by SPSS 23. Results: Out of 800 samples, the highest triage level was related to level three (79.1%) and levels two, four and one were in the next levels. 13.5% of the cases were not properly triaged according to the ESI standard and the adaptation coefficient (kappa) between the triage level specified in the patient file with the emergency severity index (ESI) triage level between physician and nurse was 58%, which was a significant difference (P<0.001). The relationship between correct triage leveling and patients’ complaints was significant (P<0.001). Conclusion: Nurses triage education about appropriate triage and ESI tool should be one of the most urgent topics and priorities of the studied hospitals. Over triage causes resources wasted and under triage may harm the patient’s health.
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Zaidi, Syed Farhan Alam, Honguk Woo, and Chan-Gun Lee. "Toward an Effective Bug Triage System Using Transformers to Add New Developers." Journal of Sensors 2022 (April 8, 2022): 1–19. http://dx.doi.org/10.1155/2022/4347004.
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As defects become more widespread in software development and advancement, bug triaging has become imperative for software testing and maintenance. The bug triage process assigns an appropriate developer to a bug report. Many automated and semiautomated systems have been proposed in the last decade, and some recent techniques have provided direction for developing an effective triage system. However, these techniques still require improvement. Another open challenge related to this problem is adding new developers to the existing triage system, which is challenging because the developers have no listed triage history. This paper proposes a transformer-based bug triage system that uses bidirectional encoder representation from transformers (BERT) for word representation. The proposed model can add a new developer to the existing system without building a training model from scratch. To add new developers, we assumed that new developers had a triage history created by a manual triager or human triage manager after learning their skills from the existing developer history. Then, the existing model was fine-tuned to add new developers using the manual triage history. Experiments were conducted using datasets from well-known large-scale open-source projects, such as Eclipse and Mozilla, and top-k accuracy was used as a criterion for assessment. The experimental outcome suggests that the proposed triage system is better than other word-embedding-based triage methods for the bug triage problem. Additionally, the proposed method performs the best for adding new developers to an existing bug triage system without requiring retraining using a whole dataset.
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Fanoos, Madonna, Abeer Hamdy, and Khaled A. Nagaty. "Bug Triage Automation Approaches." International Journal of Open Source Software and Processes 13, no. 1 (January 1, 2022): 1–19. http://dx.doi.org/10.4018/ijossp.313183.
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Bug triage is an essential task in the software maintenance phase. It is the process of assigning a developer (fixer) to a bug report. A personnel (triager) has to analyze the developers' profiles and bug reports for the purpose of making a suitable assignment. Manual bug triage consumes time and effort, so automating this process is a necessity. The previous research studies addressed the triage problem as an information retrieval problem, where the new bug report is the query. Other researchers tackled this problem as a classification problem and utilized traditional machine learning or deep learning techniques. A handful of research studies handled this problem as an optimization problem and utilized optimization algorithms such as Hungarian. This paper briefs and analyzes the previous bug triage approaches in addition to conducting an empirical comparison among five of the previous approaches.
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Gravel, Jocelyn, Sergio Manzano, and Michael Arsenault. "Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale." CJEM 10, no. 01 (January 2008): 32–37. http://dx.doi.org/10.1017/s1481803500009982.
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ABSTRACT Objective: The Paediatric Canadian Triage and Acuity Scale (PaedCTAS) stipulates that febrile patients who are 3 to 36 months old should be triaged to the PaedCTAS 3 “urgent” category. To optimize resource use, we implemented a protocol enabling these children to be down-triaged to the PaedCTAS 4 “less urgent” category if there was no sign of toxicity. Our objective was to evaluate the safety of this triage protocol modification. Methods: This retrospective cohort study evaluated all patients triaged in an urban tertiary pediatric hospital during a 6-month period between November 22, 2005, and May 22, 2006. Data were retrieved from the emergency department (ED) database and rates of hospitalization and intensive care unit (ICU) admission were compared for 4 groups: all patients triaged as urgent (level 3), all febrile patients from 3 to 36 months old triaged as urgent (level 3), all patients triaged as less urgent (level 4) and all febrile patients aged 3 to 36 months old who were down-triaged to less urgent (level 4). Results: There were 36 285 total ED visits during the study period, including 3477 febrile children who were 3 to 36 months old. Nurses down-triaged 1869 febrile children (54%) to the level-4 (less urgent) category and left 1322 (38%) in the level-3 (urgent) category. Hospitalization rate for down-triaged febrile patients was similar to that seen for all PaedCTAS 4 patients (2.4% v. 2.8%, 95% confidence interval for difference –0.3% to 1.1%). Down-triaged patients had significantly lower admission rates than those remaining in the level-3 (urgent) category (absolute risk reduction 10.7% standard deviation 1.9%, p < 0.001). No down-triaged patient died or required ICU admission. Conclusion: Febrile children aged 6 to 36 months who have no signs of toxicity can safely be down-triaged, based on triage nurse clinical judgement, to the less urgent PaedCTAS 4 category. This modification would affect the triage level of approximately 5% of all pediatric ED visits.
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Hathorn, I. F., M. L. Barnes, and R. E. Mountain. "Nurse-led triage of otolaryngology out-patient referrals: an acceptable alternative?" Journal of Laryngology & Otology 123, no. 10 (July 2, 2009): 1160–62. http://dx.doi.org/10.1017/s0022215109990399.
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AbstractObjectives:To establish the safety and effectiveness of nurse-led triage of otolaryngology out-patient referrals.Method:One hundred consecutive general practitioner referrals were reviewed by two consultants, two specialist registrars, two foundation year two senior house officers and two otolaryngology nurses. One of the nurses had received triage training. All referrals were triaged as ‘urgent’, ‘soon’ or ‘routine’ by each rater.Results:The triage-trained nurse's results demonstrated good agreement with those of the senior consultant (80 per cent). This agreement was similar to that with the other consultant (77 per cent) and the specialist registrars (79 and 82 per cent). Weighted κ statistics (correcting for chance agreement) showed that the triage-trained nurse had the second closest agreement to the senior consultant (0.66). After the actual out-patient appointments, retrospective review of the patients' case notes revealed that none had been triaged inappropriately by the trained nurse, and no urgent cases had been missed.Conclusions:Triage of out-patient referrals by trained ENT nurses is safe and effective, and is an acceptable alternative to traditional consultant vetting of referrals.
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Claudius, Ilene, Amy Kaji, Genevieve Santillanes, Mark Cicero, J. Joelle Donofrio, Marianne Gausche-Hill, Saranya Srinivasan, and Todd P. Chang. "Comparison of Computerized Patients versus Live Moulaged Actors for a Mass-casualty Drill." Prehospital and Disaster Medicine 30, no. 5 (August 12, 2015): 438–42. http://dx.doi.org/10.1017/s1049023x15004963.
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AbstractIntroductionMultiple modalities for simulating mass-casualty scenarios exist; however, the ideal modality for education and drilling of mass-casualty incident (MCI) triage is not established.Hypothesis/ProblemMedical student triage accuracy and time to triage for computer-based simulated victims and live moulaged actors using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) mass-casualty triage tool were compared, anticipating that student performance and experience would be equivalent.MethodsThe victim scenarios were created from actual trauma records from pediatric high-mechanism trauma presenting to a participating Level 1 trauma center. The student-reported fidelity of the two modalities was also measured. Comparisons were done using nonparametric statistics and regression analysis using generalized estimating equations.ResultsThirty-three students triaged four live patients and seven computerized patients representing a spectrum of minor, immediate, delayed, and expectant victims. Of the live simulated patients, 92.4% were given accurate triage designations versus 81.8% for the computerized scenarios (P=.005). The median time to triage of live actors was 57 seconds (IQR=45-66) versus 80 seconds (IQR=58-106) for the computerized patients (P<.0001). The moulaged actors were felt to offer a more realistic encounter by 88% of the participants, with a higher associated stress level.ConclusionWhile potentially easier and more convenient to accomplish, computerized scenarios offered less fidelity than live moulaged actors for the purposes of MCI drilling. Medical students triaged live actors more accurately and more quickly than victims shown in a computerized simulation.ClaudiusI, KajiA, SantillanesG, CiceroM, DonofrioJJ, Gausche-HillM, SrinivasanS, ChangTP. Comparison of computerized patients versus live moulaged actors for a mass-casualty drill. Prehosp Disaster Med.2015; 30(5): 438–442.
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Kovacs, M., and S. Campbell. "LO31: Triage drift: Variation in application of the Canadian Triage Acuity Scale between triage nurses compared to triage paramedics in response to overcrowding pressures in an emergency department." CJEM 22, S1 (May 2020): S18. http://dx.doi.org/10.1017/cem.2020.87.
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Introduction: CTAS is a validated five-level triage score utilized in EDs across Canada and internationally. Moderate interrater reliability between prehospital paramedic and triage nurse application of CTAS during clinical practice has been found. This study is the first assessment of the variation in distribution of CTAS scores with increasing departmental pressure as measured by the NEDOCs scale comparing triage allocations made by triage nurses with those made by triage paramedics. Methods: We conducted a retrospective, observational cohort study of EDIS data of all patients triaged in the Halifax Infirmary Emergency Department from January 1, 2017-May 30, 2017 and January 1, 2018 - May 30, 2018. CTAS score assignment by nursing and paramedic triage staff were compared with increasing levels of ED overcrowding, as determined by the department NEDOCS score. Results: Nurses were more likely to assign higher acuity scores in all situations of department crowding; there was a 3% increased probability that a nurse, as compared to a paramedic, would triage as emergent when the ED was not overcrowded (Pearson chi-square(1) = 4.21, p < 0.05, Cramer's v = 0.028, n = 5314), and a 10% increased probability that a nurse, as compared to a paramedic, would triage a patient as emergent when EDs were overcrowded (Pearson chi-square(1) = 623.83, p < 0.001, Cramer's v = 0.11, n = 56 018). Conclusion: Increasing levels of ED overcrowding influence triage nurse CTAS score assignment towards higher acuity to a greater degree than scores assigned by triage paramedics.
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Bazyar, Jafar, Mehrdad Farrokhi, and Hamidreza Khankeh. "Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach." Open Access Macedonian Journal of Medical Sciences 7, no. 3 (February 12, 2019): 482–94. http://dx.doi.org/10.3889/oamjms.2019.119.
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BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential.
AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study.
METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, Pubmed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions.
RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, Care Flight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems.
CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient's major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces.
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Bolduc, Claudie, Nisreen Maghraby, Patrick Fok, The Minh Luong, and Valerie Homier. "Comparison of Electronic Versus Manual Mass-Casualty Incident Triage." Prehospital and Disaster Medicine 33, no. 3 (April 17, 2018): 273–78. http://dx.doi.org/10.1017/s1049023x1800033x.
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AbstractIntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273–278.