校正改良早期预警评分系统在急性胸痛预检分诊中的应用

目的探讨校正改良早期预警评分(modified early warning scoring,MEWS)系统在急性胸痛预检分诊中的应用及效果。方法 2013年9月—2015年9月,应用MEWS系统对1556例急性胸痛患者进行预检分诊,并与应用MEWS系统前(2011年8月—2013年8月)预检分诊情况进行比较。结果应用MEWS系统进行预检分诊后,急诊胸痛患者候诊时间为(11.4±1.2)min,低于应用MEWS系统前的(20.6±1.5)min,差异有统计学意义(t=8.021,P0.05);患者分诊准确率为88.2%(1372/1556),高于应用校正MEWS系统前的79.3%(1067/1345),差异有统计学意义(χ~2=42.142,P0.01)。结论采用MEWS系统对急性胸痛患者进行分诊,可提高分诊准确率,缩短就诊时间,有利于及时诊断、及时治疗。     

校正改良式早期预警系统在心胸专科急诊分诊中的应用

目的将改良式早期预警(modified early warning score,MEWS)与胸科专科预检标准相结合,构建适用于心胸专科急诊分诊的校正MEWS系统,探讨其对于心胸专科急诊预检分诊工作的影响。方法便利抽样法选取上海交通大学附属胸科医院2015年9-12月急诊就诊患者8994例为对照组,2016年1-3月急诊就诊患者9138例为观察组。对照组患者按常规的急诊分诊流程处理,观察组患者实施校正MEWS系统的评分结果进行预检及分区分级处置,比较两组患者急诊分诊时间及分诊正确率、高危胸痛患者识别率、应急处理率,医生、护士及患者满意率。结果两组患者的分诊时间、分诊正确率、有效识别高危胸痛患者、应急处理率、患者满意率经比较,观察组患者均优于对照组,差异均有统计学意义(均P0.05)。结论校正MEWS评分系统便于急诊护士快速准确地分诊,同时可有效识别胸痛高危患者,提高心胸专科急诊预检分诊工作的可操作性及准确率,有助于急诊患者在最短时间内得到规范、科学、适当、合理、及时的救治。     

分级分区管理模式在急诊预检分诊中的应用研究

目的 探究急诊患者分级分区管理模式在提高预检分诊质量中的效果。方法 采用抽样调查法抽取在我院急诊科收治的病情Ⅲ级以上的患者160例进行统计分析,依据管理方法将2017年1-6月就诊的患者设为观察组(n=80),将2016年1-6月就诊的患者设为对照组(n=80),对2组患者的分诊准确、退换挂号情况、护理满意度进行统计分析。结果 观察组分诊准确率高于对照组(χ²=6.782,P=0.002)、退换挂号率低于对照组(χ²=3.840,P=0.050),患者对护理的满意率均高于对照组。结论 急诊患者分级分区管理模式实施能提高预检分诊质量。     

儿童急诊分诊信息系统的创建与应用研究

目的:创建基于五级预检分诊标准的儿童急诊分诊信息系统,并探讨其应用效果。方法:将2017年3月—2017年5月在医院急诊科接受治疗的10704例儿童设为对照组,以传统的“一看、二问、三查”分诊法为主;将2019年6月—2019年8月在医院急诊科接受治疗的10366例儿童设为试验组,采用基于五级预检分诊标准的急诊分诊信息系统进行分诊。比较两组就诊儿童分诊时间、分诊一致性、就诊儿童家属的满意度、医护人员的满意度。结果:对比医生和护士分诊级别,对照组患儿的Kappa值是0.58,试验组达到0.98;试验组就诊儿童的分诊时间明显短于对照组(P<0.01);在医护人员满意度、就诊儿童家属满意度方面,试验组明显高于对照组(P<0.01)。结论:基于五级预检分诊标准的儿童急诊分诊信息系统有利于减少急诊分诊时间,确保分诊有效性、准确性,明显提升就诊儿童家属、医护人员的满意度。     

"三区四级"预检分诊法在呼吸道传染病患者分诊中的临床应用

目的探讨"三区四级"预检分诊法在呼吸道传染病患者分诊中的临床应用效果。方法随机抽样选取2018年1月1~31日及2019年1月1~31日来该院急诊科就诊的呼吸道传染病患者各300例作为研究对象。将2018年患者纳入A组,采用"疾病分科"分诊法,即分诊人员根据急诊就诊患者症状和主诉分到相对应的专科诊室;2019年患者纳入B组,采用"三区四级"分诊法,即将患者的病情分为1级濒危、2级危重、3级急症、4级非急症"四级",分诊人员根据患者病情严重程度判定就诊区域及处置的优先次序,比较两组分诊人员分诊准确率、护理满意度、患者平均候诊时间、医疗纠纷发生率。结果B组分诊准确率为94.33%高于A组82.33%,差异具有统计学意义(χ2=20.960,P<0.05);B组护理满意度为93.33%高于A组80.33%,差异具有统计学意义(χ2=22.173,P<0.05);B组患者平均候诊时间(9.26±7.15)min明显少于A组(12.93±8.61)min(t=5.680,P<0.05);B组医疗纠纷发生率0.03%低于A组0.06%,差异具有统计学意义(χ2=4.693,P<0.05)。结论"三区四级"预检分诊法应用于呼吸道传染病患者分诊中效果良好,有助于提高急诊分诊准确率,降低患者平均候诊时间,降低医疗纠纷发生率,对改善呼吸道传染病患者救治率有重要的现实意义。     

虚拟挂号就诊模式在急诊预检分诊中的应用

目的观察虚拟挂号就诊模式在急诊预检分诊中的应用效果。方法预检护士在分诊时以电子预检标签为载体,点击打印电子预检标签,预检系统与挂号系统自动衔接,实现虚拟急诊挂号。采用随机等距抽样法抽取传统就诊模式(分诊-挂号-就诊)及虚拟挂号就诊模式(分诊-就诊)的急诊患者各550例,统计两组急诊患者就诊等候时间并进行比较。结果传统就诊模式平均就诊等候时间(5.17±3.45)min,虚拟挂号就诊模式平均就诊等候时间(4.01±1.03)min。结论虚拟挂号就诊模式优化了急诊就诊流程,缩短了急诊患者就诊等候时间。     

MEWS评分结合年龄和既往史在急诊患者危重程度评估中的应用价值

目的 探讨MEWS评分结合年龄和既往史在急诊危重患者分诊评估中的应用价值。 方法 选取2018年4月在我院急诊就诊的4 200例患者作为研究对象,对每位患者进行MEWS评分和MEWS结合年龄、既往史(MEWS⁺)评分,通过HIS系统对患者的去向进行追踪。绘制2种评分方法对4 200例急诊患者的ROC曲线,比较2种评分系统中患者转归情况。 结果 MEWS评分和MEWS结合年龄、既往史评分ROC曲线下的面积分别为0.68和0.84;2种方法评分<4分的患者,24h告病危、死亡的比例存在统计学差异(χ²=41.497,P<0.001)。 结论 应用MEWS结合年龄、既往史评分更能准确评估患者病情,对急诊患者病情危重程度评估有重要价值。     

急腹症分诊及急诊护理观察

目的:总结急腹症的分诊及急诊护理工作方法.方法:观察组将LarryWeed的SOAP公式应用到分诊工作中,分诊护士在观察病情过程中进行应急护理,对照组为同期经急诊住院的急腹症患者,将两组患者的诊断准确率和就诊时间进行比较.结果:两组患者的诊断准确率分别为94.3%和96.0%,两组比较差异无统计学意义(P<0.05),两组患者就诊时间分别为(1.27±0.63)h和(2.87±1.52)h,两组比较差异有统计学意义(P<0.001).结论:急腹症的分诊及护理是抢救治疗成功的关键.     

优化急诊就诊流程与分诊标准的研究

[目的]优化急诊预检分诊流程,合理配置分诊护士,制订病情分诊标准,提高预检分诊的准确率,在正确的时间(分类)和正确的地点(分区)给急诊病人以正确的治疗.[方法]根据危急、危重、紧急、非紧急病情制订急诊分诊标准并实施.同时采用自行设计问卷,对前来就诊的154例病人针对急诊医疗分诊工作进行抽样调查.[结果]实施新型分诊流程后,82%就诊病人表示认同.[结论]急诊分诊标准为危急重症病人提供了最佳的就诊时间,兼顾到普通病人的利益,保证了所有急诊病人的安全就诊.分类诊治保证了安全,分区诊治保证了质量,提高了病人的就诊满意度.     

分级分区分诊在急诊科的应用及效果评价

目的:探讨分级分区分诊体系在急诊科的应用及效果,以强化服务意识和急救意识,提高患者满意度。方法:采用自制问卷调查法,分别对开展分区分级分诊前后在急诊科就诊的患者及分诊护士进行问卷调查,比较实施急诊科分级分区分诊前后的分诊正确率。结果:影响分诊正确的因素主要包括患者因素、护士因素、管理者因素,实施后的急诊分诊正确率较实施前明显提高(P0.01)。结论:急诊分级分区分诊提高了分诊的准确率,为患者赢得抢救时间,建议推广应用。     

改良早期预警评分管理模式在急诊留观患者中的应用研究

目的 探讨改良早期预警评分(MEWS)在急诊留观患者风险管理中的应用价值.方法 通过动态监测MEWS,决定患者处理策略和去向;比较不同流向患者评分的差异;调查医生、护士对实施MEWS管理模式的满意度.结果 评分无动态变化的245例患者MEWS为(2.6±1.2)分;有动态变化的44例中,直接收住院的32例患者评分为(4.6±1.7)分;转抢救室12例患者评分为(6.2±2.4)分.各组患者评分比较差异均有统计学意义(2.6±1.2 vs.4.6±1.7,t=3.44,P=0.003;2.6±1.2 vs.6.2±2.4,t=5.10,P=0.000;4.6±1.7 vs.6.2±2.4,t=2.79,P=0.007);医生、护士对实施MEWS动态监测前后的留观患者管理满意度分别为75.5%和94.3%,前后比较差异有统计学意义(χ~2 =7.36,P＜0.01).结论 MEWS可作为急诊留观患者风险管理和合理分流的有效工具,值得临床推广.     

Which triage category patients die in hospital after being admitted through emergency departments? A study in one teaching hospital

Abstract Objectives: To quantify the number of deaths per triage category (scale 1–5, Australian National Triage Scale) occurring after admission to hospital via an emergency department and to examine the causes of death in each category. Setting: St Vincent's Hospital, Melbourne (Victoria, Australia) is an acute adult tertiary referral hospital. Methods: Electronic collection of all hospital admissions and their subsequent destination for the calendar year 1997, with chart and/or postmortem review to determine the cause of death. Results: The percentage of deaths per triage group decreased with urgency. Numerically, the largest group of all admissions and admissions followed by deaths consist of patients presenting in category 4 (semi-urgent). Conclusions: Triage categories may be a useful tool for prioritizing acute patients, but patients in low triage categories often have fatal illnesses. Performance measurements and workload assessments for emergency departments may need to involve category 4 patients to take account of this factor.     

Effect of a triage course on quality of rating triage codes in a group of university nursing students:a before-after observational study

BACKGROUND:

Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting. In this study we analyzed if a course on a new four-level triage model, triage emergency method (TEM), could improve the quality of rating in a group of nursing students.

METHODS:

This observational study was conducted with paper scenarios at the University of Parma, Italy. Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM. We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students’ predictions with the triage code rating of a reference standard (a panel of five experts in the new triage method).

RESULTS:

Inter-rater reliability was K=0.42 (95%CI: 0.37–0.46) before the course on TEM, and K=0.61 (95%CI: 0.56–0.67) after. The accuracy of students’ triage rating for the reference standard triage code was good: 81% (95%CI: 71–90). After the TEM course, the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts.

CONCLUSION:

Among the group of nursing students, a brief course on triage and on a new in-hospital triage method seems to improve the quality of rating codes. The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.KEY WORDS: Emergency, Reliability, Triage, Triage system, Validity     

情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响

目的探讨情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响。方法采用整群便利抽样法,选取2017年6月至2019年6月本院急诊科低年资护士25名作为研究对象。将情景模拟训练方法引入护士急救培训工作中,比较培训前后护士急救事件岗位胜任能力得分、护士急救技能得分。结果在模拟训练6个月后急诊护士专业知识、专业技术、专业能力及个人综合素质评分均显著高于训练前(P<0.05);CPR、插管配合、洗胃、吸痰、静脉穿刺及电除颤技能评分均显著高于训练前(P<0.05);综合操作时间短于培训前(P<0.05)。结论情景模拟训练应用于低年资急诊分诊护士中,可以显著提高低年资急诊护士的岗位胜任能力和急救技能水平,对提高医院急救成功率及护理水平均具有重要意义。     

Different triage categorization using Emergency Severity Index (ESI) method in emergency department

Objective

Triage is basically a categorization process to prioritize various treatments for patients based on the types of disease, severity, prognosis and resource availability. However, the term triage is more appropriate to be used in the context of natural disaster or mass casualties. Within the context of emergency situation in emergency department, the term triage refers to a method used to assess the severity of patients’ condition, determine the level of priority, and mobilize the patients to the suitable care unit. ESI is a new concept of triage using five scales in classifying the patients in emergency department. The real implementation of this concept demands nurses have to immediately make assessment about patients’ condition right away, besides they must give their final decision, whether to move the patients to the ward or to let them leave the hospital.

Impacts of the introduction of a triage system in Japan: A time series study

The aim of the present study was to measure and compare the effectiveness of nursing triage before and after introduction of the Japanese Triage and Acuity Scale (JTAS), the Japanese version of the Canadian Triage and Acuity Scale (CTAS), during emergency treatment. Surveys of triage nurses and emergency physicians were conducted before and after JTAS introduction. Respondents were triage nurses (before 112 cases, after 94 cases), emergency physicians (before 50, after 41), and triaged patients (before 1057, after 1025) from seven separate emergency medical facilities. The results showed that nursing triage using the JTAS shortened “time from registration to triage” by 3.8 min, “triage duration” by 1 min, “time from registration to physician” by 11.2 min, and “waiting time perceived by patients to see a physician” by 18.6 min (p < 0.001). The difference in assigned level of urgency between triage nurses and emergency physicians decreased from 34.2% to 12.2% (p < 0.001), over-triage decreased from 24.7% to 8.6% (p < 0.001), and under-triage decreased from 9.5% to 3.6% (p < 0.001). Furthermore, assessment agreement between triage nurses and emergency physicians increased significantly, from weighted κ = 0.486 to weighted κ = 0.820. These findings suggest that the introduction of the JTAS promoted more effective nursing triage and medical care.     

Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey

IntroductionThe quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making.MethodA total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form.ResultPrior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability.ConclusionEmergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.     

The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department triage

The Canadian Triage and Acuity Scale has received widespread acceptance in Canada as a reliable and valid tool for emergency department triage. The importance of accurate triage becomes more apparent as emergency department volumes increase, and resources shrink. The need to ensure that those patients requiring more urgent care receive care first is the basis for all triage scales. Through the Canadian Triage and Acuity Scale National Working Group, the scale became the recommended triage tool for Canadian emergency departments. Work has been done on the interrater reliability of Canadian Triage and Acuity Scale among health care providers. There is a need to further assess the validity of the scale. This scale has now been applied in the out of hospital setting by paramedics and is being used in measurements of emergency physician workload. The future may see an electronic triage tool develop for emergency department use to reduce variability in its application. The Canadian Triage and Acuity Scale has become an integral component of Canadian emergency departments.