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

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments

Exploring demographic and lifestyle associations with patient experience following telephone triage by a primary care doctor or nurse:secondary analyses from a cluster randomised controlled trial

The ESTEEM trial was a cluster randomised controlled trial that compared two telephone triage management systems (general practitioner (GP) or a nurse supported by computer decision support software) with usual care, in response to a request for same-day consultation in general practice

Telephone triage and seizure management for community-based ID/DD: A research synthesis

Nurse and physician clinicians often guide seizure care for individuals with intellectual and developmental disability (ID/DD) through telephone triage. This article evaluated the evidence for epilepsy management tools with a focus on the telephone triage tool. Studies were included in the systematic review, data was extracted, followed by meta-aggregated findings. A rigorous methodological protocol was used as described by The Cochrane Collaboration. All quantitative or descriptive studies that included epilepsy management tools or protocols for persons with ID/DD living in a community-based setting were considered. No tools specific to ID/DD seizure management via telephone triage were discovered. Study results reveal a possible gap in clinical care. Research findings did support the use of telephone triage tools and epilepsy protocols for clinicians. These findings may improve seizure management by focusing ID/DD clinicians on the advantages of using such tools. Findings may also illuminate the need for seizure management tools specific to the ID/DD population

Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate

Introduction Methods Results Discussion Conclusion Abstract Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocal cervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where the high-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects the colposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undetermined significance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classification systems. The meta-analysis was restricted to studies, published between 1991 and 2007. A random-effect model was applied for meta-analytical pooling and the influence of covariates on the HPV positivity rate was analyzed by meta-regression. The variation by age was assessed within individual studies since age strata were not defined uniformly. On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%). In women with LSIL, the pooled positivity rate was 76% (95% CI: 71-81%; range 55-89%). In spite of considerable inter-study heterogeneity, the difference in HPV positivity between the two triage groups was large and highly significant: 32% (95% CI: 27-38%). HPV rates dropped tremendously as age and cutoffs of test positivity increased. Other factors (cytological classification system, country, continent, collection method and year of publication) had no statistically significant impact, except in LSIL triage where HPV positivity was significantly lower in European compared to American studies. Women with LSIL, especially younger women, have high HPV positivity rates suggesting limited utility of reflex HPV triaging these cases. Research is needed to identify more specific methods to triage women with low-grade squamous cervical lesions

A simple tool to predict admission at the time of triage

Aim To create and validate a simple clinical score to estimate the probability of admission at the time of triage. Methods This was a multicentre, retrospective, cross-sectional study of triage records for all unscheduled adult attendances in North Glasgow over 2 years. Clinical variables that had significant associations with admission on logistic regression were entered into a mixed-effects multiple logistic model. This provided weightings for the score, which was then simplified and tested on a separate validation group by receiving operator characteristic (ROC) analysis and goodness-of-fit tests. Results 215 231 presentations were used for model derivation and 107 615 for validation. Variables in the final model showing clinically and statistically significant associations with admission were: triage category, age, National Early Warning Score (NEWS), arrival by ambulance, referral source and admission within the last year. The resulting 6-variable score showed excellent admission/discharge discrimination (area under ROC curve 0.8774, 95% CI 0.8752 to 0.8796). Higher scores also predicted early returns for those who were discharged: the odds of subsequent admission within 28 days doubled for every 7-point increase (log odds=+0.0933 per point, p&#60;0.0001). Conclusions This simple, 6-variable score accurately estimates the probability of admission purely from triage information. Most patients could accurately be assigned to ‘admission likely’, ‘admission unlikely’, ‘admission very unlikely’ etc., by setting appropriate cut-offs. This could have uses in patient streaming, bed management and decision support. It also has the potential to control for demographics when comparing performance over time or between departments.</p

The second gamma-H2AX assay inter-comparison exercise carried out in the framework of the European biodosimetry network (RENEB)

Purpose: Within the EU RENEB project, seven laboratories have taken part in training and harmonisation activities to strengthen triage gamma H2AX-based radiation exposure assessment. This has culminated in a second triage biodosimetry exercise. Materials and methods: Whole blood and separated lymphocyte samples were homogenously irradiated with 60Co gamma rays at 0.5, 2.5 (blind samples), 0 and 2 Gy (reference samples). Following post-exposure incubations of 4 and 24 h, 16 samples were shipped on ice packs to each partner. The samples were stained and scored for gamma-H2AX foci, using manual and/or automated fluorescence microscope scoring strategies. Dose estimates were obtained and used to assign triage categories to the samples. Results: Average dose estimates across all the laboratories correlated well with true doses. The most accurate assignment of triage category was achieved by manual scoring of the 4-h blood and lymphocyte samples. Only three samples out of a total of 46 were miscategorized in a way that could have adversely effected the clinical management of a radiation casualty. Conclusions: This inter-comparison exercise has demonstrated that following a recent acute radiation exposure, the gamma-H2AX assay could be a useful triage tool that can be successfully applied across a network of laboratories

Challenge Patient Dispatching in Mass Casualty Incidents

Efficient management of mass casualty incidents is complex, since regular emergency medical services struc-tures have to be switched to a temporary “disaster mode” involving additional operational and tactical struc-tures. Most of the relevant decisions have to be taken on-site in a provisional and chaotic environment. Data gathering about affected persons is one side of the coin; the other side is on-site patient dispatching requiring information exchange with the regular emergency call center and destination hospitals. In this paper we extend a previous conference contribution about the research project e-Triage to the aspect of patient data and on-site patient dispatching. Our considerations reflect the situation in Germany, which deserves from our point of view substantial harmonization

Emergency and critical care services in Tanzania: a survey of ten hospitals.

While there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries. We assessed the structure and availability of resources for Emergency and Critical Care in Tanzania in order to identify the priorities for improving care in this neglected specialty. Ten hospitals in four regions of Tanzania were assessed using a structured data collection tool. Quality was evaluated with standards developed from the literature and expert opinion. Important deficits were identified in infrastructure, routines and training. Only 30% of the hospitals had an emergency room for adult and paediatric patients. None of the seven district and regional hospitals had a triage area or intensive care unit for adults. Only 40% of the hospitals had formal systems for adult triage and in less than one third were critically ill patients seen by clinicians more than once daily. In 80% of the hospitals there were no staff trained in adult triage or critical care. In contrast, a majority of equipment and drugs necessary for emergency and critical care were available in the hospitals (median 90% and 100% respectively. The referral/private hospitals tended to have a greater overall availability of resources (median 89.7%) than district/regional hospitals (median 70.6). Many of the structures necessary for Emergency and Critical Care are lacking in hospitals in Tanzania. Particular weaknesses are infrastructure, routines and training, whereas the availability of drugs and equipment is generally good. Policies to improve hospital systems for the care of emergency and critically ill patients should be prioritised

Use of an Evidence‐Based Guideline for Management of Side Effects from Long‐Acting Reversible Contraceptives: A Quality Improvement Report

Introduction Many health care providers believe that women who initiate long‐acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence‐based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations. Process A telephone triage guideline was adapted from the Contraceptive Choice Project\u27s Clinician Call Back System, supplemented with evidence‐based resources, and approved by clinicians at 2 community women\u27s health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated. Outcomes Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation. Discussion Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects