ارزیابی صحت تریاژ پرستاران در بخش اورژانس بیمارستان شهید باهنر کرمان: یک مطالعه‌ی مقطعی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 رزیدنت، گروه طب اورژانس، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی کرمان، کرمان، ایران

2 استادیار، گروه طب اورژانس، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی کرمان، کرمان، ایران

3 دانشیار، گروه طب اورژانس، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی کرمان، کرمان، ایران

چکیده

مقاله پژوهشی




مقدمه: تریاژ، فرایند ارزیابی و طبقه‌بندی بیماران به منظور بهبود مدیریت و ارائه‌ی خدمات است. یک سیستم تریاژ خوب باید قادر به شناسایی دقیق بیمارانی باشد که نیاز به مراقبت فوری پزشکی دارند. شاخص شدت اضطرار (Emergency severity index) ESI، در حال حاضر پرکاربردترین روش برای تریاژ و یک سیستم تریاژ معتبر است. هدف از این مطالعه، بررسی توانایی پرستاران بخش اورژانس در تریاژ صحیح بیماران با استفاده از ESI بود.
روش‌ها: مطالعه‌ی مقطعی حاضر، بر روی 272 بیمار مراجعه‌کننده به اورژانس بیمارستان شهید باهنر کرمان در تیرماه 1401 می‌باشد. تریاژ بیماران که توسط پرستاران اورژانس انجام شده بود با تریاژ تعیین شده توسط پزشکان مقایسه شد. ضریب کاپا بین دو گروه (پرستاران و پزشکان) برای تعیین توافق، مورد ارزیابی قرار گرفت.
یافته‌ها: تریاژ برای 72/1 درصد از 272 بیمار به درستی شناسایی شد، در حالی که 13/6 درصد تریاژ سبک و 14/3 درصد تریاژ سنگین شده بودند. اولویت تنها برای 56/6 درصد بیماران دقیق بود و به 7/1 درصد از بیماران، اولویت کمتری اختصاص داده شده بود. سطح توافق بین دو گروه، که با ضریب کاپا اندازه‌گیری شد برابر با 5/60 درصد بود.
نتیجه‌گیری: در این مطالعه توافق تریاژ به دست آمده در حد متوسط بود. با این حال فرایند تریاژ بیشتر از اینکه خطرناک باشد، ناکارآمد بود. برنامه‌های آموزشی طولانی‌مدت برای افزایش دقت تریاژ توصیه می‌شود.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Assessing the Accuracy of Nurse Triage in Emergency Department of Shahid Bahonar Hospital of Kerman: A Cross-Sectional Study

نویسندگان [English]

  • Fatemeh Bardsiri 1
  • Masoomeh Nazemi-Rafi 2
  • Amin Saberinia 3
1 Resident, Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
2 Assistant Professor, Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
3 Associate Professor, Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
چکیده [English]

Background: Triage is the process of assessing and categorizing patients to improve management and service delivery. A reliable triage system should be capable of accurately identifying patients who require immediate medical attention. The emergency severity index (ESI) is currently the most widely used method for triage, and it is a validated triage system. This study aimed to assess the ability of emergency department nurses to triage patients utilizing ESI.
Methods: A cross-sectional study was conducted on 272 patients who were referred to the emergency department (ED) of Shahid Bahonar Hospital of Kerman in July 2022. The triage of the patients was performed by emergency nurses, and the results were compared with those determined by physicians. Cohen's kappa coefficient was evaluated between the two groups (nurses and physicians) to determine the inter-rater agreement.
Findings: The triage group was correctly identified for 72.1% (196) of the 272 patients, while 13.6% (37) were under-triaged and 14.3% (39) were over-triaged. The priority was accurate for only 56.6% of patients, and 7.1% of patients received a lower priority. The agreement level between the two groups was 60.5% (95% CI: 0.532-0.677) measured by the kappa coefficient.
Conclusion: In this study, the agreement that was found in terms of patients’ triage was average. Although the triage was more inefficient than risky, long-term training programs are highly recommended for enhancing the accuracy of the triage.

کلیدواژه‌ها [English]

  • Accuracy
  • Nurses
  • Physicians
  • Triage
  • Urgency
  1. Javidi S, Movahedi M, Honarmand A, Mirafzal A. Emergency severity index triage in Iran: A comparison between age groups in a trauma center. Adv Emerg Nurs J 2023; 45(2): 145-53.
  2. Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med 2018; 18(1): 1-7.
  3. Bazyar J, Farrokhi M, Salari A, Safarpour H, Khankeh HR. Accuracy of triage systems in disasters and mass casualty incidents; a systematic review. Arch Acad Emerg Med 2022; 10(1): e32.
  4. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000; 7(3): 236-42.
  5. Tanabe P, Gilboy N, Travers DA. Emergency severity index version 4: Clarifying common questions. J Emerg Nurs 2007; 33(2): 182-5.
  6. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on the emergency severity index version 3. Acad Emerg Med 2004; 11(1): 59-65.
  7. McHugh M, Tanabe P, McClelland M, Khare RK. More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. Acad Emerg Med 2012; 19(1): 106-9.
  8. Fekonja Z, Kmetec S, Fekonja U, Mlinar Reljić N, Pajnkihar M, Strnad M. Factors contributing to patient safety during triage process in the emergency department: A systematic review. J Clin Nurs 2023; 32(17-18): 5461-77.
  9. AlMarzooq AM. Emergency department nurses’ knowledge regarding triage. Int J Nurs 2020; 7(2): 29-44.
  10. Ouellet S, Galliani MC, Gélinas C, Fontaine G, Archambault P, Mercier É, et al. Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol. Nurs Open 2023; 10(5): 2770-9.
  11. Warriner Z, Bernard AC. Geriatric trauma: Triage guidelines. Curr Trauma Reports 2020; 6(4): 125-32.
  12. Naing L, Nordin RB, Abdul Rahman H, Naing YT. Sample size calculation for prevalence studies using Scalex and ScalaR calculators. BMC Med Res Methodol 2022; 22(1): 209.
  13. McHugh ML. Interrater reliability: the kappa statistic. Biochem Medica (Zagreb) 2012; 22(3): 276-82.
  14. Pishbin E, Ebrahimi M, Mirhaghi A. Do physicians and nurses agree on triage levels in the emergency department? A meta-analysis. Notfall und Rettungsmedizin 2019; 22(7): 379-85.
  15. Rahmani F, Sepehri Majd P, Ebrahimi Bakhtavar H, Rahmani F. Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis. J Emerg Pract Trauma 2018; 4(1): 9-13.
  16. Green NA, Durani Y, Brecher D, Depiero A, Loiselle J, Attia M. Emergency severity index version 4: A valid and reliable tool in pediatric emergency department triage. Pediatr Emerg Care 2012; 28(8):
    753-7.
  17. Durani Y, Brecher D, Walmsley D, Attia MW, Loiselle JM. The emergency severity index version 4: Reliability in pediatric patients. Pediatr Emerg Care 2009; 25(8): 504-7.
  18. Jafari-Rouhi AH, Sardashti S, Taghizadieh A, Soleimanpour H, Barzegar M. The Emergency Severity Index, version 4, for pediatric triage: A reliability study in Tabriz Children’s Hospital, Tabriz, Iran. Int J Emerg Med 2013; 6(1): 36.
  19. Considine J, Botti M, Thomas S. Do knowledge and experience have specific roles in triage Decision-making? Acad Emerg Med 2007; 14(8): 722-6.
  20. Hinson JS, Martinez DA, Schmitz PSK, Toerper M, Radu D, Scheulen J, et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med 2018; 11(1): 3.
  21. Ghanbarzehi N, Balouchi A, Sabzvari S, Darban F, Khayat NH. Effect of triage training on concordance of triage level between triage nurses and emergency medical technicians. J Clin Diagnostic Res 2016; 10(5): IC05-7.
  22. Recznik CT, Simko LM. Pediatric triage education: An integrative literature review. J Emerg Nurs 2018; 44(6): 605-613.e9.
  23. Brosinski CM, Riddell AJ, Valdez S. Improving triage accuracy: A staff development approach. Clin Nurse Spec 2017; 31(3): 145-8.
  24. Jarvis S, De Freitas S. Evaluation of an immersive learning program to support triage training. In: Proceedings of the 2009 Conference in Games and Virtual Worlds for Serious Applications, VS-GAMES 2009; [2009 Mar 23-24]; Coventry, UK. p. 117-22.
  25. Göransson KE, Ehrenberg A, Marklund B, Ehnfors M. Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs 2006; 14(2): 83-8.
  26. Chen SS, Chen JC, Ng CJ, Chen PL, Lee PH, Chang WY. Factors that influence the accuracy of triage nurses’ judgement in emergency departments. Emerg Med J 2010; 27(6): 451-5.
  27. Wuerz R, Fernandes CMB, Alarcon J. Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med 1998; 32(4): 431-5.
  28. Dilley S, Standen P. Victorian nurses demonstrate concordance in the application of the National Triage Scale. Emerg Med 1998; 10(1): 12-8.
  29. Ali Rahmanto, Loeki Enggar Fitri, Ika Setyo Rini. Analysis of nurse personal factors of triage decision-making in emergency installation at the University of Muhammadiyah Malang Hospital. Indian J Forensic Med Toxicol 2021; 15(4): 994-1002.

Lee E, Kim EK. Factors influencing triage nurses’ Korean triage and acuity scale performance ability.
J Korean Clin Nurs Res 2018; 24(1): 94-102