Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

System and method for determining triage categories

Embodiments disclosed herein provide a system, method, and computer program product for providing a triage clas- sification system. The triage classification system uses a computer model that is developed using historical patient data. The developed computer modelis applied to collected patientattributedatafromapatientinapre-hospitalsetting to generate a triage category. Based on the generated triage category, health care professionals can take desired actions, suchastransportingthepatienttoafacilitymatchingthe generated triage category.Board of Regents, University of Texas Syste

Relationships Between Triage Knowledge, Training, Working Experiences and Triage Skills Among Emergency Nurses in East Java, Indonesia

Background: Since there are increased numbers of clients with traumatic injuries and non-traumatic cases in the emergency department in Indonesia, triage skill is an essential competency required for the emergency nurses.Purposes: This study aimed to examine the level of perceived triage skills and the relationship between knowledge, training, working experience and perceived triage skills among emergency nurses.Method: Two hundred and sixty six emergency room (ER) nurses working in two secondary and two tertiary public hospitals in East Java Province, Indonesia, were recruited by purposive sampling. Data were collected using a set of questionnaires which included the Demographic Data including training and working experiences, Triage Knowledge Questionnaire (TKQ) and Triage Skill Questionnaire (TSQ). The contents of questionnaires were validated by three experts and tested for reliability. The correlation coefficient for the TKQ was 0.99 and Cronbach\u27s alpha coefficient of the TSQ was 0.93. The collected data were analyzed using descriptive statistics including Pearson\u27s product-moment correlation to examine the relationship.Result: The results showed that the majority of subjects were female (71.4%) with aged of 22 – 40 years (79.3%), educated to diploma level (94.4%). All subjects had attended Basic Life Support (BLS) and Advanced Life Support (ACLS), and about half of them had greater than 5 years working experiences in ED. Overall perceived triage skill was at a moderate level with the mean score of 75.12 (SD = 11.23). There were significantly positive correlations between triage skill and working experience (r = .27, p < .01), training experience (r = .37, p < .01), and triage knowledge (r = .38, p < .01).Conclusion: The findings provide a better understanding of triage skills among ER nurses and suggest that the continuing education and training courses related to triage and advanced management of medical emergencies for ER nurses are required in order to increase and update the triage skills in enhancing the quality of emergency care and patient safety

A Case-Based Reasoning Method for Locating Evidence During Digital Forensic Device Triage

The role of triage in digital forensics is disputed, with some practitioners questioning its reliability for identifying evidential data. Although successfully implemented in the field of medicine, triage has not established itself to the same degree in digital forensics. This article presents a novel approach to triage for digital forensics. Case-Based Reasoning Forensic Triager (CBR-FT) is a method for collecting and reusing past digital forensic investigation information in order to highlight likely evidential areas on a suspect operating system, thereby helping an investigator to decide where to search for evidence. The CBR-FT framework is discussed and the results of twenty test triage examinations are presented. CBR-FT has been shown to be a more effective method of triage when compared to a practitioner using a leading commercial application

Visual analysis of document triage data

As part of the information seeking process, a large amount of effort is invested in order to study and understand how information seekers search through documents such that they can assess their relevance. This search and assessment of document relevance, known as document triage, is an important information seeking process, but is not yet well understood. Human-computer interaction (HCI) and digital library scientists have undertaken a series of user studies involving information seeking, collected a large amount of data describing information seekers' behavior during document search. Next to this, we have witnessed a rapid increase in the number of off-the-shelf visualization tools which can benefit document triage study. Here we set out to utilize existing information visualization techniques and tools in order to gain a better understanding of the large amount of user-study data collected by HCI and digital library researchers. We describe the range of available tools and visualizations we use in order to increase our knowledge of document triage. Treemap, parallel coordinates, stack graph, matrix chart, as well as other visualization methods, prove to be insightful in exploring, analyzing and presenting user behavior during document triage. Our findings and visualizations are evaluated by HCI and digital library researchers studying this proble

Mobile forensic triage for damaged phones using M_Triage

Mobile forensics triage is a useful technique in a digital forensics investigation for recovering lost or purposely deleted and hidden files from digital storage. It is particularly useful, especially when solving a very sensitive crime, for example, kidnapping, in a timely manner. However, the existing mobile forensics triage tools do not consider performing a triage examination on damaged mobile phones. This research addressed the issues of performing triage examination on damaged Android mobile phones and reduction of false positive result generated by the current mobile forensics triage tools. Furthermore, the research addressed the issues of ignoring possible evidence residing in a bad block memory location. In this research a new forensics triage tool called M_Triage was introduced by extending Decode’s framework to handle data retrieval challenges on damaged Android mobile phones. The tool was designed to obtain evidence quickly and accurately (i.e. valid address book, call logs, SMS, images, and, videos, etc.) on Android damaged mobile phones. The tool was developed using C#, while back end engines was done using C programming and tested using five data sets. Based on the computational time processing comparison with Dec0de, Lifter, XRY and Xaver, the result showed that there was 75% improvement over Dec0de, 36% over Lifter, 28% over XRY and finally 71% over Xaver. Again, based on the experiment done on five data sets, M_Triage was capable of carving valid address book, call logs, SMS, images and videos as compared to Dec0de, Lifter, XRY and Xaver. With the average improvement of 90% over DEC0DE, 30% over Lifter, 40% over XRY and lastly 61% over Xaver. This shows that M_Triage is a better tool to be used because it saves time, carve more relevant files and less false positive result are achieved with the tool

Investigating visualisation techniques for rapid triage of digital forensic evidence

This study investigates the feasibility of a tool that allows digital forensics (DF) investigators to efficiently triage device datasets during the collection phase of an investigation. This tool utilises data visualisation techniques to display images found in near real-time to the end user. Findings indicate that participants were able to accurately identify contraband material whilst using this tool, however, classification accuracy dropped slightly with larger datasets. Combined with participant feedback, the results show that the proposed triage method is indeed feasible, and this tool provides a solid foundation for the continuation of further work

Triage Process in Emergency Departments: an Indonesian Study

Background: Triage process has rapidly developed in some countries in the last three decades in order to respond to the demand for emergency services by growing population and emergency health needs. However, this development does not appear to match in Indonesian hospitals. The triage process in Indonesia remains obscure.Purpose: This study aimed to describe triage process in Indonesia from a range of different perspectives.Methods: The research design of this study was descriptive qualitative using semistructured interviews of 12 policy makers or persons responsible from 5 different organizations which informed triage practice in Indonesia. The data were analyzed using a three step content analysis.Results: The result produced 3 themes. First, four steps of triage process ranging from receiving to prioritizing were reported as the triaging procedures in Indonesia which were almost similar to the International literature except for a re-triage step. Second,primary and secondary triage processes were also applied in all emergency departments in Indonesia. Last, no prolonged waiting time in Indonesia could be assumed whether the triage process was effective and efficient or it was only a quick process of sorting to rapidly increase the number of patients in the treatment rooms. Out of the themes, the result also indicated that the involvement of nurses in health policy development inIndonesia needed supportConclusion: Triage process in Indonesia still needs improvements. Patient\u27s re-triage and evaluating secondary triage should be given more frameworks in the future. An effective and efficient triage process in Indonesia will best manage the number of patients in the treatment rooms and therefore further observational researches on patterns and trends are needed. Moreover, including the role of nurses as policy makers in the curriculum of nursing undergraduate and post-graduate degrees would give nurses the evidence to seek out policy making positions in the futur

Portinari: A Data Exploration Tool to Personalize Cervical Cancer Screening

Socio-technical systems play an important role in public health screening programs to prevent cancer. Cervical cancer incidence has significantly decreased in countries that developed systems for organized screening engaging medical practitioners, laboratories and patients. The system automatically identifies individuals at risk of developing the disease and invites them for a screening exam or a follow-up exam conducted by medical professionals. A triage algorithm in the system aims to reduce unnecessary screening exams for individuals at low-risk while detecting and treating individuals at high-risk. Despite the general success of screening, the triage algorithm is a one-size-fits all approach that is not personalized to a patient. This can easily be observed in historical data from screening exams. Often patients rely on personal factors to determine that they are either at high risk or not at risk at all and take action at their own discretion. Can exploring patient trajectories help hypothesize personal factors leading to their decisions? We present Portinari, a data exploration tool to query and visualize future trajectories of patients who have undergone a specific sequence of screening exams. The web-based tool contains (a) a visual query interface (b) a backend graph database of events in patients' lives (c) trajectory visualization using sankey diagrams. We use Portinari to explore diverse trajectories of patients following the Norwegian triage algorithm. The trajectories demonstrated variable degrees of adherence to the triage algorithm and allowed epidemiologists to hypothesize about the possible causes.Comment: Conference paper published at ICSE 2017 Buenos Aires, at the Software Engineering in Society Track. 10 pages, 5 figure