Education to improve the triage of mental health patients in general hospital emergency departments

General hospital emergency departments (EDs) are obvious places for individuals in distress or in a mental health crisis to seek assistance. However, triage nurses admit to a lack of expertise and confidence in psychiatric assessment which can result in less accurate assessments than for medical or trauma presentations. The objectives of a collaborative project between an Adult Mental Health Program and an Adult Emergency Program in a Canadian regional health authority were to: provide education and training to triage nurses regarding mental health and illness; monitor the transit of mental health patients through the ED; monitor wait times; and determine the adequacy of the Canadian Triage Acuity and Assessment Scale in the triage of psychiatric presentations. Although the percentages of patients triaged as "emergent" did not change as a result of the education, the percentage of patients who were triaged as "not urgent" but required hospitalization was significantly reduced. Although average lengths of stay in the ED were also reduced after the education, this may or may not have been related to the educational sessions. The project was successful in increasing collaboration between the two departments and has resulted in enhanced, on-going mental health education for ED nurses.     

Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education Kit

Objective: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. Methods: A postal survey of 237 paper‐based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was κ ≥ 0.6. Results: Data were collected during 2 April to 14 May 2007. Agreement for the set was κ = 0.412 (95% CI 0.410–0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6–45.3) showed concordance ≥70% to the modal triage category (κ = 0.632, 95% CI 0.629–0.636) and 155/237 (65.4%, 95% CI 59.3–71.5) showed concordance ≥60% to the modal triage category (κ = 0.507, 95% CI 0.504–0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (κ = 0.243, 95% CI 0.237–0.249; κ = 0.319, 95% CI 0.310–0.328). Conclusion: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task‐related factors influence consistency of triage.     

曼彻斯特分诊系统在急救部门安全管理中的应用

[目的]探讨曼彻斯特分诊系统(MTS)在急救部门安全管理中的应用效果。[方法]应用曼彻斯特分诊系统对急诊病人实施层级管理,处理分诊过程中的关键活动,制定MTS流程图和层级标志。[结果]实施曼彻斯特分诊系统后护士层级分诊总准确率较高,达86.5%;红色级、橙色级和蓝色级分诊准确率相对较高,分别为90.0%、92.8%、100.0%;过度分诊率较低,仅为6.3%。心脏骤停发生率由23.8%降至3.0%。[结论]实施曼彻斯特分诊系统可提高分诊准确率、提升分诊质量、有效节约急诊资源,是一种有效的安全管理手段。     

标准操作规范在急诊接诊与分流中的应用

目的 探讨急诊接诊与分流中应用标准操作规范的方法与效果.方法 制订急诊接诊与分流标准操作规范,合理配置人力资源并进行培训.结果 加快了急诊接诊与分流速度(P<0.05),分诊失误率下降(P<0.01),患者满意度提高(P<0.05).结论 规范化、科学的急诊接诊与分流标准实现了快速救治,提高了患者满意度.     

Imaging of fibroadenoma: Be careful with imaging follow-up

The present letter to the editor is related to the study titled, “Preoperational diagnosis and management of breast ductal carcinoma in situ arising within fibroadenoma: Two case reports.” Fibroadenoma is the most common benign mass lesion in young females. Based on this study showing that malignancy can develop on fibroadenomas, we want to emphasize that careful sonographic follow-up of fibroadenomas should be done and that each lesion should be followed carefully and separately in cases with multiple fibroadenomas. Additionally, we want to emphasize the critical role of sonographic examination in diagnosing fibroadenoma, the importance of correctly defining benign and malignant sonographic findings, and which lesions should be followed up sonographically and which lesions should be evaluated histopathologically.     

Current triage practice and influences affecting clinical decision-making in emergency departments in NSW, Australia

In Australia, as elsewhere, the nature of triage decision making, patient referral, investigations, physical resources, triage policies, educational requirements and clinical expertise is often unclear and differs between organizations (Gerdtz & Bucknell 2000; Standen 1998). The study described here was undertaken in order to explore current triage practices throughout New South Wales (NSW) and to describe the range of clinical reasoning tasks performed by nurses.     

Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement

Introduction  

It has been proposed that intensive care unit (ICU)-acquired weakness (ICUAW) should be assessed using the sum of manual muscle strength test scores in 12 muscle groups (the sum score). This approach has been tested in patients with Guillain-Barré syndrome, yet little is known about the feasibility or test characteristics in other critically ill patients. We studied the feasibility and interobserver agreement of this sum score in a mixed cohort of critically ill and injured patients.     

胸痛患者急诊预检分诊的研究进展

急性高危胸痛可在短时间内出现病情快速变化甚至死亡,预检分诊可对患者进行快速病情评估并判定其优先级,是急性胸痛患者风险评估的关键环节。该文阐述急性胸痛患者急诊预检分诊标准、评估方法和工具,分析其相关影响因素并提出展望,旨在为急诊预检分诊胸痛管理提供参考。     

我国二级及以上医院急诊分诊依据现状调查

目的调查国内急诊分诊执行情况及分诊依据的现状。方法采用自制调查问卷,对国内113所医院的274名急诊科护士进行急诊分诊执行情况及分诊依据现状的调查。结果目前急诊分诊护士要求不统一,急诊分诊标准存在不足,急诊分诊护士现有培训不能满足临床需要。结论我国在急诊分诊护士培养和急诊分诊标准的建立等方面尚不完善,建立统一规范的分诊标准和专职分诊护士将成为急诊分诊发展的趋势。     

快速分诊评估系统在急诊患者中的应用

目的 研究针对急诊患者的快速分诊评估系统,建立评估模式及方法,筛选评估指标和内容,帮助分诊护士准确快速辨识急危重患者,使其得到及时救治,优化使用急救医疗资源.方法 筛选目标人群,采集相关资料研究分析,设计建立研究模型,采集涵盖急诊患者危急重症主要表现和特征的评估指标及内容,选择确定急诊分诊评估指引系统的表达形式.结果 将研究选定的评估指标、评估内容采用表格化形式表达,建立急诊护士快速分诊指引评估表,指导护士分诊工作.结论 本研究设计的急诊护士快速分诊指引评估表,简洁直观、使用方便,能有效地提高护士分诊工作质量,具有一定实用性、科学性和创新性.兼顾到以有限的急救医疗资源取得优质的急诊医疗服务的结果,具有一定的社会效益和经济效益.

Abstract：

Objective To study the quick triage assessment system for emergency nurse, establish evaluation model and method, select indicators and contents, guide triage nurses to be accurate, fast, convenient and practical, and also to optimize the use of emergency medical resources. Methods Screening the target population to conduct the research, collecting main indicators and features covered with main symptom and characteristics of severe critical emergency patients, selecting manifestation form of triage assessment system. Results The selected indicators and contents were demonstrated by a table-based form, and the quick triage assessment form for emergency nurse was established to instruct triage work. Conclusions This established quick triage assessment form is simple, intuitive and can improve the quality of emergency triage work. It possesses feasibility, practicality and achieves the optimal medical services with the limited emergency medical resources, which shows both social and economic effect.     

Current trends in emergency triage in Taiwan: the five-level triage system

An ideal triage system should accurately and quickly sort patients according to seriousness of diseases, and ensure that patients in emergency departments (EDs) get adequate management in an appropriate medical environment. Recently, EDs throughout the world have been confronting overcrowding, and are developing a five-level triage system to solve the problems that this presents. Taiwan EDs have used the Taiwan triage system (TTS) since 1999 until recently. In order to follow the trend of the times, EDs in Taiwan adjusted the four-level TTS to a five-level system, and built a computer system which is reliable and effective. This article reviews the literature about emergency triage systems, and describes the differences between the four-level and five-level systems, exploring the reliability, effectiveness, and outcomes of triage systems. Taiwan nurses might treat this article as a basis for reflection on the importance of the five-level triage system.