Computerized algorithm-directed triage in the emergency department

Berman, David A.; Coleridge, Samuel TaylorHG; McMurry, Ted A.

doi:10.1016/s0196-0644(89)80102-7

Cited by 41 publications

(13 citation statements)

References 14 publications

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“…5 In addition, studies on gatekeepers report that 0.25% to 1.9% of nonurgent patients triaged to sites other than the ED are admitted the same day. [10][11][12][13] Our data support the difficulty in using incomplete patient information. Approximately one third of patients deemed inappropriate by any of these three methods ultimately had an ED discharge diagnosis that was serious.…”

Section: Discussionsupporting

confidence: 68%

Do Internists and Emergency Physicians Agree on the Appropriateness of Emergency Department Visits?

et al. 1997

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The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. For 892 adult patient ED visits reviewed, we found only moderate agreement (kappa = 0.47) between these groups. In cases of disagreement, emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED care. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on access to timely care in office settings.

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Section: Discussionsupporting

confidence: 68%

Do Internists and Emergency Physicians Agree on the Appropriateness of Emergency Department Visits?

et al. 1997

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“…Early work on a computerized triage system in a military setting demonstrated the ability to triage personnel to either an acute care clinic or an ED. 25 This system is not applicable to the vast majority of civilian settings and essentially uses a 2-level triage system (acute care clinic v. the ED). More recently, Grafstein and colleagues found high reliability with PC-linked triage, in which each presenting complaint was linked to one or more specific CTAS levels, thus directing the triage nurse toward the preferred triage levels for each complaint type.…”

Section: Discussionmentioning

confidence: 99%

The effect of training on nurse agreement using an electronic triage system

Dong

Bullard

Meurer

et al. 2007

CJEM

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Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training. Methods: This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted κ) statistics. Results: In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted κ = 0.55; 95% confidence interval [CI] 0.49-0.62); agreement improved in phase 2 (weighted κ = 0.65; 95% CI 0.60-0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods. Conclusions: Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted. RÉSUMÉObjectifs : Le triage à l'urgence attribue aux patients une priorité fondée sur l'urgence des soins nécessaires et l'Échelle canadienne de triage et de gravité (ECTG) constitue à cette fin la norme nationale. Nous décrivons la concordance entre évaluateurs et les dérogations manuelles des infirmières qui utilisent un outil de triage électronique conforme à l'ECTG (eTRIAGE) pour deux degrés différents de formation du personnel. Méthodes : Cette étude prospective a été réalisée au service d'urgence d'un établissement de soins tertiaires en milieu urbain. Au cours de la phase 1, on a déployé le système eTRIAGE après ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

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“…Similar to triage itself, the developmental roots of the SRTS are found in the military. In 1989, Berman et al reported their experience using an algorithm-driven triage system at Brooke Army Medical Center (21). Patients were triaged by corpsmen using a binary logic pathway that would result in a triage assignment to the ED or the Acute Care Clinic.…”

Section: The Soterion Rapid Triage Systemmentioning

confidence: 99%