Recent Emergency Study in Recent Emergency Study in PalestinePalestine

Triage SystemTriage SystemAt Al – Makassed HospitalAt Al – Makassed Hospital

Emergency DepartmentEmergency Department Jamal Al-WahadnehJamal Al-Wahadneh

20092009

This Study Was Done This Study Was Done

By ED Team By ED Team

At At

Makassed Hospital Makassed Hospital

Jerusalem Jerusalem

Triage class 2005

Objective:Objective:

Define triageDefine triage Define the effective triage Define the effective triage systemsystem

Identify mistriage patientsIdentify mistriage patients

Triage:Triage:

Is the process of sorting or Is the process of sorting or classifying patients classifying patients

according to urgency of according to urgency of condition or complaint.condition or complaint.

Effective triage system:Effective triage system:

It’s designed to get the It’s designed to get the patient to the right place, at patient to the right place, at the right time, with the right the right time, with the right

care provider.care provider.

Why Triage?

•Save Time.

•Organize Work.

•Control Crowd.

•Reduce work load.

Why Triage?

• Better care.

• Reduce stress.

• Communication

• Reduce errors

•Patient /staff satisfaction•Screen for misdiagnosis•Cost effectiveness•Improve nursing practice standards•Improve competencies

Why Triage?

Goal of studyGoal of study

Comparison of two nurses triage Comparison of two nurses triage for each patient to determine the for each patient to determine the acuity level according to acuity level according to emergency severity index ESI.emergency severity index ESI.

ESIESIQ1- is patient dying ?Q1- is patient dying ?

LEVEL 2LEVEL 2

YESYES

LEVEL 1LEVEL 1

NONO

LEVELLEVEL2,3,4,52,3,4,5

Q2-Q2- can patient wait ?can patient wait ?

NONO YESYES

LEVEL 3,4,5LEVEL 3,4,5

Q3- Number of diagnosticQ3- Number of diagnosticresources neededresources needed

Two or more – level 3Two or more – level 3 One – level 4One – level 4 Non – level 5Non – level 5

Objectives of the studyObjectives of the study

1.1. To evaluate and assess ER triage nurses skills & To evaluate and assess ER triage nurses skills & knowledge of triage system.knowledge of triage system.

1.1. Evaluate the reliability of ESI between two triage Evaluate the reliability of ESI between two triage nursesnurses. .

2.2. To assess mistriage cases among ER triage To assess mistriage cases among ER triage nurses.nurses.

Triage class 2005

DefinitionsDefinitions

1.1. Mistriage:Mistriage: refers to assignment of an acuity level refers to assignment of an acuity level that is higher or lower than necessary for specific that is higher or lower than necessary for specific patient.patient.

1.1. Over triage:Over triage: assignment of a higher acuity level assignment of a higher acuity level than necessary.than necessary.

1.1. Under triage:Under triage: is potentially more serious because is potentially more serious because patient receive an acuity level that is lower than patient receive an acuity level that is lower than appropriate, delays treatment because under appropriate, delays treatment because under triage can lead to increase mortality and morbidity. triage can lead to increase mortality and morbidity.

Data collectionData collection

Number of patients involved in the study:Number of patients involved in the study:

120 patients120 patients

Methodology:Methodology:1.1. InterviewInterview

2.2. Patient assessmentPatient assessment

Study designStudy designSimple random sampling design was usedSimple random sampling design was used

Results:Results:

Level 1Level 1 Level 2Level 2 Level 3Level 3 Level 4Level 4 Level 5Level 5

9 27 32 44 8

Results / con’tResults / con’t

1.1. Out of 120 patients, only 3 patients refused to be Out of 120 patients, only 3 patients refused to be interviewed by the 2interviewed by the 2ndnd triage nurse (level 2 & 3). triage nurse (level 2 & 3).

1.1. Out of 120 patients, 4 patients were unable to respond to Out of 120 patients, 4 patients were unable to respond to 11stst and 2 and 2ndnd triage nurses (comatosed but triaged). triage nurses (comatosed but triaged).

1.1. 96 out of 117 patients were triaged by 196 out of 117 patients were triaged by 1stst and 2 and 2ndnd nurse nurse had the same acuity level.had the same acuity level.

1.1. 79 out of 113 were assessed by the 179 out of 113 were assessed by the 1stst and 2 and 2ndnd triage nurse triage nurse had the same pain scale.had the same pain scale.

Results / con’tResults / con’t

Mistriaging: Mistriaging: in patients with different acuity levels in patients with different acuity levels

(21/117)(21/117)

1.1. Over triageOver triage (level 2 &3) 16/21patients (level 2 &3) 16/21patients 9/16 patients were mistriaged by the 19/16 patients were mistriaged by the 1stst nurse. nurse. 7/16 patients were mistriaged by the 27/16 patients were mistriaged by the 2ndnd nurse. nurse.

2.2. Under triageUnder triage (level 2 & 3) 5/21 (level 2 & 3) 5/21 3/5 patients were mistriaged by the 13/5 patients were mistriaged by the 1stst nurse. nurse. 2/5 patients were mistriaged by the 22/5 patients were mistriaged by the 2ndnd nurse. nurse.

Results / con’tResults / con’t

Mistriage among patient with the same acuity levels Mistriage among patient with the same acuity levels were 8/96 (level2 & 3).were 8/96 (level2 & 3).

6/8 patients were over triaged by both nurses6/8 patients were over triaged by both nurses2/8 patients were under triaged by both nurses2/8 patients were under triaged by both nurses

ACLS Class 2005

Recommendation:~Recommendation:~

Safety triage system is related to the ability to Safety triage system is related to the ability to

detect the critically ill (started by visual detect the critically ill (started by visual assessment).assessment).

Continue offering the triage course for health Continue offering the triage course for health care professionals -ED team- in order to care professionals -ED team- in order to improve triage accuracy.improve triage accuracy.

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