Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners

Linden, Christien van der; Lindeboom, Robert; Linden, Naomi van der; Lucas, Cees

doi:10.1016/j.ienj.2011.06.001

Cited by 16 publications

(4 citation statements)

References 28 publications

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“…The use of NPs to meet health service and community needs is discussed widely in the literature 34,[51][52][53][54] with numbers of NPs in Australia expected to rise by as much as 94% by 2025. 55 An ED NP is an independent practitioner who is able to assess, diagnose, treat, prescribe and refer to other health specialties.…”

Section: Expanded Ed Nursing Scope Of Practicementioning

confidence: 99%

Review article: Systematic review of three key strategies designed to improve patient flow through the emergency department

Elder

Johnston

Crilly

2015

Emerg Medicine Australasia

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To explore the literature regarding three key strategies designed to promote patient throughput in the ED. CINAHL, Medline, PubMed, Scopus and Australian Government databases were searched for articles published between 1980 and 2014 using the key search terms ED flow/ throughput, ED congestion, crowding, overcrowding, models of care, physician-assisted triage, medical assessment units, nurse practitioner, did not wait (DNW) and ED length of stay (LOS). Abstracts and articles not published in English and articles published before 1980 were excluded from the review. Quantitative and qualitative studies were considered for inclusion. The National Health Medical Research Council (NHMRC) Level of Evidence Hierarchy (2009) was applied to included studies. Twenty-one articles met criteria for review. The level of evidence assessed using the NHMRC guidelines of studies ranged from I to IV, with the majority falling into the Level II-2 (n = 6) and III-3 (n = 9) range. ED LOS was the outcome most often reported. Study quality was limited with few studies adjusting for confounding factors. Only one level I systematic review was included in this review. Advanced practice nursing roles, physician-assisted triage and medical assessment units are models of care that can positively impact ED throughput. They have been shown to decrease ED LOS and DNW rates. Confounding factors, such as site specific staffing requirements, patient acuity and rest-of-hospital processes, can also impact on patient throughput through the ED.

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Section: Expanded Ed Nursing Scope Of Practicementioning

confidence: 99%

Review article: Systematic review of three key strategies designed to improve patient flow through the emergency department

Elder

Johnston

Crilly

2015

Emerg Medicine Australasia

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“…Previous studies have shown that overcrowding leads to increased health costs, decreased efficiency and quality of care, and increased incidence of adverse events and mortality, all of which culminate in poor performance of the health care system (4)(5)(6)(7) . To prioritize health care for severely ill patients, hospitals have instituted triage systems in recent decades with the aim of identifying patients with more severe conditions and with increased risk of death, thereby ensuring faster service with minimal waiting time (1,(8)(9)(10)(11)(12) . Several protocols and scores are available to triage patients using different levels of severity, but the use of protocols that stratify risk in five levels is recommended because of their increased validity and reliability in assessing the clinical conditions of the patient (2,12,13) .…”

Section: Introductionmentioning

confidence: 99%

Triage at the Emergency Department: association between triage levels and patient outcome

Becker

Lopes

Pinto

et al. 2015

Rev. esc. enferm. USP

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Objective: Identify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP). Method: Retrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05). Results: Men with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001). Conclusion:The high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

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“…In most cases, an external evaluation process (i.e. external validity) provides a better reflection of a triage system's performance as it can be compared to the performance of other triage systems throughout the world [34].…”

Section: Triage Validitymentioning

confidence: 99%

Triage system performance: consistency and accuracy in the emergency centre

Dippenaar

2020

Journal of Paramedic Practice

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Triage systems have evolved over recent times with the use of tiered acuity to achieve a balance between patient need and resource availability. Triage is a way to sort patients based on acuity, irrespective of the setting, and whether by telephone, in the prehospital environment or in hospital. The growth of the paramedic profession means that paramedics are now working in emergency centres and having to contend with the concept of triage in this setting. The nature of emergency centres and the variety of patient presentations makes it nearly impossible to have a perfect system that is both consistent and accurate. Paramedics, as decision makers, should understand the underlying concepts of what makes a triage system perform well so best practice can be adopted with specific goals in mind. There is a patient-centred focus to do the most for the most at any given time and to ensure that resources are aligned with the needs of patients. It is vital to monitor a triage system's performance so that improvements or adjustments can be made in response to patient population needs over time. This commentary focuses on the main principles of triage system performance measures and what factors should be taken into consideration during clinical practice. Highlighting the concepts of triage reliability, validity and decision-making should help paramedics to understand the importance of conscious decision-making practice.

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Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners

Cited by 16 publications

References 28 publications

Review article: Systematic review of three key strategies designed to improve patient flow through the emergency department

Review article: Systematic review of three key strategies designed to improve patient flow through the emergency department

Triage at the Emergency Department: association between triage levels and patient outcome

Triage system performance: consistency and accuracy in the emergency centre

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