An overview of triage in the emergency department

Ganley, Lorraine; Gloster, Annabella

doi:10.7748/ns2011.11.26.12.49.c8829

Cited by 25 publications

(12 citation statements)

References 16 publications

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“…On arrival, all patients were routinely triaged by an ED nurse according to the Manchester Triage Scale (MTS) system [ 9 ]. Patient evaluation and physiological measurements necessary to calculate NEWS were obtained concurrently by the ED triage nurse or, as soon as possible, by the recruiting researcher.…”

Section: Methodsmentioning

confidence: 99%

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study

Bilben

Grandal

Søvik

2016

Scand J Trauma Resusc Emerg Med

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BackgroundNational Early Warning Score (NEWS) was designed to detect deteriorating patients in hospital wards, specifically those at increased risk of ICU admission, cardiac arrest, or death within 24 h. NEWS is not validated for use in Emergency Departments (ED), but emerging data suggest it may be useful. A criticism of NEWS is that patients with chronic poor oxygenation, e.g. severe chronic obstructive pulmonary disease (COPD), will have elevated NEWS also in the absence of acute deterioration, possibly reducing the predictive power of NEWS in this subgroup. We wanted to prospectively evaluate the usefulness of NEWS in unselected adult patients emergently presenting in a Norwegian ED with respiratory distress as main symptom.MethodsIn respiratory distressed patients, NEWS was calculated on ED arrival, after 2–4 h, and the next day. Manchester Triage Scale (MTS) category, age, gender, comorbidity (ASA score), ICU-admission, ventilatory support, and discharge diagnoses were noted. Survival status was tracked for >90 days through the Population Registry. Data are medians (25–75th percentiles). Factors predicting 90-day survival were analysed with multiple logistic regression.ResultsWe included 246 patients; 71 years old (60–80), 89 % home-dwelling, 74 % ASA 3–4, 72 % MTS 1–2, 88 % admitted to hospital. NEWS on arrival was 5 (3–7). NEWS correlated closely with MTS category and maximum in-hospital level of care (ED, ward, high-dependency unit, ICU). Sixteen patients died in-hospital, 26 died after discharge within 90 days. Controlled for age, ASA score, and COPD, a higher NEWS on ED arrival predicted poorer 90-day survival. Increased NEWS also correlated with decreased 30-day- and in-hospital survival and a decreased probability for home-dwelling patients to be discharged directly home.DiscussionIn respiratory distressed patients, NEWS on ED arrival correlated closely with triage category and need of ICU admission and predicted long-term out-of-hospital survival controlled for age, comorbidity, and COPD.ConclusionsNEWS should be explored in the ED setting to determine its role in clinical decision-making and in communication along the acute care chain.

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Section: Methodsmentioning

confidence: 99%

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study

Bilben

Grandal

Søvik

2016

Scand J Trauma Resusc Emerg Med

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“…Patients are classified according to clinical severity, level of suffering and risk to their own health. In this way, triage is defined as a dynamic process of patient classification that allows patients to be allocated to the most suitable service for faster treatment (Ganley and Gloster, 2011).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the Manchester Triage System: a systematic review

Azeredo

Guedes

Almeida

et al. 2015

International Emergency Nursing

101

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“…CDSSs have been used in hospitals [ 15 , 28 , 29 ], primary [ 27 ] and chronic care setting [ 30 , 31 ], and for phone-based counselling [ 32 – 34 ]. However, few studies have evaluated TM nurses’ reasoning using these systems to manage patients with COPD in the primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Advancing beyond the system: telemedicine nurses’ clinical reasoning using a computerised decision support system for patients with COPD – an ethnographic study

Barken¹,

Thygesen²,

Söderhamn³

2017

BMC Med Inform Decis Mak

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BackgroundTelemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses’ reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses’ clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated.MethodsIn this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis.ResultsWhen telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: “the process of telemedicine nurses’ reasoning to assess health change” and “the influence of the telemedicine setting on nurses’ reasoning and decision-making processes”. An overall theme, termed “advancing beyond the system”, represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses’ clinical reasoning process.ConclusionIn the telemedicine setting, when supported by a computerised decision support system, nurses’ reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses’ reasoning process. Nurses’ reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses’ reasoning process.

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An overview of triage in the emergency department

Cited by 25 publications

References 16 publications

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study

Efficacy of the Manchester Triage System: a systematic review

Advancing beyond the system: telemedicine nurses’ clinical reasoning using a computerised decision support system for patients with COPD – an ethnographic study

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