The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland.
ABSTRACT Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.
Article: An advance triage system.[show abstract] [hide abstract]
ABSTRACT: This paper describes the redesign of the triage process in an Emergency Department with the purpose of improving the patient flow and thus increasing patient satisfaction through the reduction of the overall length of stay. The process, Advance Triage, allows the triage nurse to initiate diagnostic protocols for frequently occurring medical problems based on physician-approved algorithms. With staff and physician involvement and medical specialist approval, nine Advance Triage algorithms were developed-abdominal pain, eye trauma, chest pain, gynaecological symptoms, substance abuse, orthopaedic trauma, minor trauma, paediatric fever and paediatric emergent. A comprehensive educational program was provided to the triage nurses and Advance Triage was initiated. A process was established at one year to evaluate the effectiveness of the Advance Triage System. The average length of stay was found to be 46 min less for all patients who were advance triaged with the greatest time-saving of 76 min for patients in the 'Urgent' category. The most significant saving was realized in the patient's length of stay (LOS) after the Emergency Physician assessed them because diagnostic results, available during the initial patient assessment, allowed treatment decisions to be made at that time. Advance Triage utilizes patient waiting time efficiently and increases the nurses' and physicians' job satisfaction.Accident and Emergency Nursing 02/2002; 10(1):10-6.
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ABSTRACT: Triage nurses’ clinical decision making. An observational study of urgency assessmentBackground. Researchers have described both the various decision tasks performed by triage nurses using self-report methods and identified time as a factor influencing the quality of triage decisions. However, little is known about the decision tasks performed by triage nurses when making acuity assessments, or the factors influencing triage duration in the real world.Aims. The aims of this study were to: describe the data triage nurses collect from patients in order to allocate a triage priority using the Australasian Triage Scale (ATS); describe the duration of nurses’ decision making for ATS categories 2–5; and to explore the impact of patient and nurse variables on the duration of the triage nurses’ decision making in the clinical setting.Design. A structured observational study was employed to address the research aims. Observational data was collected in one adult emergency department located in metropolitan Melbourne, Australia. A total of 26 triage nurses consented and were observed performing 404 occasions of triage. Data was collected by a single observer using a 20-item instrument that recorded the performance frequencies of a range of decision tasks and a number of observable patient, nurse and environmental variables. Additionally, the nurse–patient interaction was recorded as time in minutes.Results. It was found that there was limited use of objective physiological data collected by the nurses’ in order to decide patient acuity, and large variability in the duration of triage decisions observed. In addition, analysis of variance indicated strong evidence of a true difference between triage duration and a range of nurse, patient and environmental variables.Conclusion. These findings have implications for the development of practice standards and triage education. In particular, it is argued that practice standards should include routine measurement of physiological parameters in all but the collapsed or obviously unwell patient, where further delay may impede the delivery oftime-critical intervention. Furthermore, the inclusion of arbitrary time frames for triage assessment in practice standards are not an appropriate method of evaluating triage decision making in the real world.Journal of Advanced Nursing 08/2001; 35(4):550 - 561. · 1.53 Impact Factor
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ABSTRACT: To determine the rate of interobserver reliability of the Canadian Emergency Department Triage and Acuity Scale (CTAS). Ten physicians and 10 nurses were randomly selected to review and assign a triage level on 50 ED case summaries containing presenting complaint, mode of arrival, vital signs, and a verbatim triage note. The rate of agreement within and between groups of raters was determined using kappa statistics. One-way, 2-way analysis of variance (ANOVA) and combined ANOVA were used to quantify reliability coefficients for intraclass and interclass correlations. The overall chance-corrected agreement kappa for all observers was.80 (95% confidence interval [CI] .79 to .81), and the probability of agreement between 2 random observers on a random case was.539. For nurses alone, kappa=.84 (95% CI .83 to .85, P = .598), and for doctors alone, kappa= .83 (95% CI .81 to .85, P = .566). The 1-way, 2-way ANOVA and combined ANOVA showed that the reliability coefficients (84%) for both nurses and physicians were similar to the kappa values. A combined ANOVA showed there was a. 2-point difference with physicians assigning a higher triage level. The high rate of interobserver agreement has important implications for case mix comparisons and suggests that this scale is understood and interpreted in a similar fashion by nurses and physicians.Annals of Emergency Medicine 09/1999; 34(2):155-9. · 4.29 Impact Factor