Emergency triage: comparing a novel computer triage program with standard triage.
Acad Emerg Med
; 12(6): 502-7, 2005 Jun.
Article
en En
| MEDLINE
| ID: mdl-15930400
BACKGROUND: Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed. OBJECTIVES: To determine the agreement between a computer decision tool and memory-based triage. METHODS: Consecutive patients presenting to a large, urban, tertiary care ED were assessed in the usual fashion and by a blinded study nurse using a computerized decision support tool. Triage score distribution and agreement between the two triage methods were reported. A random subset of patients was selected and reviewed by a blinded expert panel as a consensus standard. RESULTS: Over five weeks, 722 ED patients were assessed; complete data were available from 693 (96%) score pairs. Agreement between the two methods was poor (kappa = 0.202; 95% confidence interval [95% CI] = 0.150 to 0.254); however, agreement improved when using weighted kappa (0.360; 95% CI = 0.305 to 0.415) or "within one" level kappa (0.732; 95% CI = 0.644 to 0.821). When compared with the expert panel, the nurse triage scores showed lower agreement (0.263; 95% CI = 0.133 to 0.394) than the tool (kappa = 0.426; 95% CI = 0.289 to 0.564). There was a significant down-triaging of patients when patients were triaged without the computerized tool. Admission rates also differed between the triage systems. CONCLUSIONS: There was significant discrepancy by nurses using memory-based triage when compared with a computer tool. Triage decision support tools can mitigate this drift, which has administrative implications for EDs.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Toma de Decisiones Asistida por Computador
/
Triaje
/
Enfermería de Urgencia
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Aspecto:
Implementation_research
Límite:
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Acad Emerg Med
Asunto de la revista:
MEDICINA DE EMERGENCIA
Año:
2005
Tipo del documento:
Article
País de afiliación:
Canadá
Pais de publicación:
Estados Unidos