scholarly journals Validity and reliability of the triage scale in older people in a regional emergency department in Hong Kong

2020 ◽  
pp. 102490792097163
Author(s):  
Kai Yeung Cheung ◽  
Ling Pong Leung
Keyword(s):  
Emergency Department ◽  
Hong Kong ◽  
Confidence Interval ◽  
Older People ◽  
Expert Panel ◽  
Validity And Reliability ◽  
Triage Category ◽  
Life Saving ◽  
Emergency Department Triage ◽  
Emergency Department Patients

Background: Older people (⩾65 years) present a unique challenge in emergency department triage. Hong Kong’s Hospital Authority adopts a five-level emergency department triage system, with no special considerations for older people. We evaluated the validity and reliability of this triage scale in older people in a regional Hong Kong emergency department. Methods: In total, 295 cases stratified by triage category were randomly selected for review from November 2016 to January 2017. Validity was established by comparing the real emergency department patients’ triage category against (1) that of an expert panel and (2) the need for life-saving intervention. Triage notes were extracted to make case scenarios to evaluate inter- and intra-rater reliabilities. Emergency department nurses (n = 8) were randomly selected and grouped into <5 and ⩾5 years emergency department experience. All nurses independently rated all 295 scenarios, blinded to clinical outcomes. Results: The percentage agreement between the real emergency department patients’ triage category and the expert panel’s assignment was 68.5%, with 16.3% and 15.3% over-triage and under-triage, respectively. Quadratic weighting kappa for agreement with the expert panel was 0.72 (95% confidence interval: 0.53–0.91). The sensitivity, specificity and positive likelihood ratio for the need for life-saving interventions were 75.0% (95% confidence interval: 47.6%–92.7%), 97.1% (95% confidence interval: 94.4%–98.8%) and 26.2 (95% confidence interval: 12.5%–54.8%), respectively. The Fleiss kappa value for inter-rater reliability was 0.50 (95% confidence interval: 0.47–0.54) for junior and senior nurse groups, respectively. Conclusion: The current triage scale demonstrates reasonable validity and reliability for use in our older people. Considerations highlighting the unique characteristics of older people emergency department presentations are recommended.

scholarly journals Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life-saving Intervention

2010 ◽  
Vol 17 (3) ◽  
pp. 238-243 ◽  
Author(s):  
Timothy F. Platts-Mills ◽  
Debbie Travers ◽  
Kevin Biese ◽  
Brenda McCall ◽  
Steve Kizer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severity Index ◽  
Emergency Severity Index ◽  
Life Saving ◽  
Emergency Department Patients

Incidence of panic disorder in patients with non-cardiac chest pain and panic attacks

2019 ◽  
pp. 135910531985906
Author(s):  
Jenny-Lee Heppell ◽  
Isabelle Denis ◽  
Stéphane Turcotte ◽  
Richard P Fleet ◽  
Clermont E Dionne ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Panic Disorder ◽  
Confidence Interval ◽  
Anxiety Sensitivity ◽  
Odds Ratio ◽  
Structured Interview ◽  
Elevated Risk ◽  
Panic Attacks ◽  
Emergency Department Patients

This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.

scholarly journals Blood Culture Collection through Peripheral Intravenous Catheters Increases the Risk of Specimen Contamination among Adult Emergency Department Patients

2012 ◽  
Vol 33 (5) ◽  
pp. 524-526 ◽  
Author(s):  
Wesley H. Self ◽  
Theodore Speroff ◽  
Candace D. McNaughton ◽  
Patty W. Wright ◽  
Geraldine Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Relative Risk ◽  
Blood Culture ◽  
Confidence Interval ◽  
Culture Collection ◽  
Blood Cultures ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Emergency Department Patients ◽  
Intravenous Catheters

Five hundred five blood cultures collected through a peripheral intravenous catheter (PIV) in an emergency department were matched to cultures obtained by dedicated venipuncture from the same patient within 10 minutes. The relative risk of contamination for cultures collected through PIVs compared with dedicated venipuncture was 1.83 (95% confidence interval, 1.08–3.11).

scholarly journals Development and Refinement of a Persuasive Health Communication Intervention to Persuade Adult Emergency Department Patients to be Screened for HIV and Hepatitis C

SAGE Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 215824402110475
Author(s):  
Roland C. Merchant ◽  
David Hernandez ◽  
Dora Estrela ◽  
Elsie Fernandez ◽  
Melissa A. Clark ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C ◽  
Health Communication ◽  
Communication Intervention ◽  
Final Version ◽  
Life Saving ◽  
Usual Clinical Practice ◽  
Patients At Risk ◽  
Emergency Department Patients ◽  
Hcv Testing

Screening for HIV and hepatitis C (HCV) in emergency departments (EDs) allows patients to benefit from life-saving treatment; however, some patients at risk for these infections decline to be tested. Interventions that overcome patient reluctance to be screened are needed so that infected patients can be linked with care. In this project, we developed a very brief, theory-based, persuasive health communication intervention (PHCI) drawn from our previous research that can be integrated into usual clinical practice. The intervention was revised with the assistance of stakeholders who would likely either deliver the intervention (ED medical staff or HIV/HCV counselors) and those who would receive it (adult ED patients). The final version of the intervention was rated as both persuasive and respectful of ED patients who initially declined HIV/HCV testing.

405 Elevated Blood Pressure in Emergency Department Patients in Hong Kong: Prevalence, Characteristics and Disposition

2012 ◽  
Vol 60 (4) ◽  
pp. S142-S143 ◽  
Author(s):  
C.A. Graham ◽  
S.S. Chan ◽  
I. Ahmad ◽  
T.H. Rainer
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Hong Kong ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Emergency Department Patients

scholarly journals Correlation between the pre-hospital triage scale and emergency department triage scale

2019 ◽  
Vol 26 (5) ◽  
pp. 281-287
Author(s):  
Sil Sung ◽  
Chan Young Kang ◽  
Hee Young Lee ◽  
Jung Hun Lee ◽  
Oh Hyun Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Medical Center ◽  
Kappa Coefficient ◽  
Emergency Patient ◽  
Hospital Visit ◽  
Triage System ◽  
Emergency Medical ◽  
Level 3 ◽  
Emergency Department Triage

Background:While emergency patient triage system is effective when the pre-hospital triage acuity scale is linked with the in-hospital triage acuity scale. However, the 119 emergency medical triage system and the Korea Triage and Acuity Scale are not linked in Korea.Objective:This study aimed to investigate the correlation between the two triage systems and to utilize the results as basic data for the future development of a pre-hospital triage system.Methods:Among the 1114 patients who visited a regional emergency medical center by a 119 ambulance from April to May 2016, we analyzed the correlation between the pre-hospital and in-hospital triage systems based on the general characteristics of the patients and their reason of hospital visit (non-trauma or trauma).Results:Upon reclassifying the pre-hospital and in-hospital triage systems into three levels, among the 289 patients (28.1%) in level 3 of the pre-hospital triage, 79 (27.3%) were reclassified as the highest level (Resuscitation) in the in-hospital triage. The kappa coefficient as a measure of agreement between the two triage systems was very low at 0.211 (95% confidence interval, 0.164–0.258), and the kappa coefficient of the paramedic category was 0.232 (95% confidence interval, 0.161–0.303).Conclusion:There is a low agreement between the pre-hospital and in-hospital triage systems.

scholarly journals NEWS and qSIRS superior to qSOFA in the prediction of 30-day mortality in emergency department patients in Hong Kong

2020 ◽  
Vol 52 (7) ◽  
pp. 403-412
Author(s):  
Colin A. Graham ◽  
Ling Yan Leung ◽  
Ronson Sze Long Lo ◽  
Chun Yu Yeung ◽  
Suet Yi Chan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hong Kong ◽  
Emergency Department Patients

scholarly journals Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study

CJEM ◽  
2009 ◽  
Vol 11 (04) ◽  
pp. 321-329 ◽  
Author(s):  
Jonathan F. Dreyer ◽  
Shelley L. McLeod ◽  
Chris K. Anderson ◽  
Michael W. Carter ◽  
Gregory S. Zaric
Keyword(s):  
Emergency Department ◽  
Staffing Levels ◽  
Physician Staffing ◽  
Triage Category ◽  
Emergency Department Triage ◽  
Physician Time ◽  
Time Required ◽  
Staffing Needs ◽  
Research Assistants ◽  
Mean Time

ABSTRACTIntroduction:The Canadian Emergency Department Triage and Acuity Scale (CTAS) is a 5-level triage tool used to determine the priority by which patients should be treated in Canadian emergency departments (EDs). To determine emergency physician (EP) workload and staffing needs, many hospitals in Ontario use a case-mix formula based solely on patient volume at each triage level. The purpose of our study was to describe the distribution of EP time by activity during a shift in order to estimate the amount of time required by an EP to assess and treat patients in each triage category and to determine the variability in the distribution of CTAS scoring between hospital sites.Methods:Research assistants directly observed EPs for 592 shifts and electronically recorded their activities on a moment-by-moment basis. The duration of all activities associated with a given patient were summed to derive a directly observed estimate of the amount of EP time required to treat the patient.Results:We observed treatment times for 11 716 patients in 11 hospital-based EDs. The mean time for physicians to treat patients was 73.6 minutes (95% confidence interval [CI] 63.6–83.7) for CTAS level 1, 38.9 minutes (95% CI 36.0–41.8) for CTAS-2, 26.3 minutes (95% CI 25.4–27.2) for CTAS-3, 15.0 minutes (95% CI 14.6–15.4) for CTAS-4 and 10.9 minutes (95% CI 10.1–11.6) for CTAS-5. Physician time related to patient care activities accounted for 84.2% of physicians' ED shifts.Conclusion:In our study, EPs had very limited downtime. There was significant variability in the distribution of CTAS scores between sites and also marked variation in EP time related to each triage category. This brings into question the appropriateness of using CTAS alone to determine physician staffing levels in EDs.

Exploring the Predictors of Emergency Department Triage Acuity Assignment in Patients With Sepsis

2018 ◽  
Vol 50 (2) ◽  
pp. 81-88
Author(s):  
Leon Petruniak ◽  
Maher El-Masri ◽  
Susan Fox-Wasylyshyn
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Medical Attention ◽  
Emergency Rooms ◽  
Related Factors ◽  
Delayed Treatment ◽  
Emergency Department Triage ◽  
Triage Classification

Background and purpose Evidence suggests that septic patients, who require prompt medical attention, may be undertriaged, resulting in delayed treatment. The purpose of this study was to examine patient and contextual variables that contribute to high- versus low-acuity triage classification of patients with sepsis. Methods Data were abstracted from the medical records of 154 adult patients with sepsis admitted to hospital through a Canadian Emergency Department. Logistic regression was used to explore the predictors of triage classification. Results Language barriers or chronic cognitive impairment (odds ratio 5.7; 95% confidence interval 2.15, 15.01), acute confusion (odds ratio 3.4; confidence interval 1.3, 8.2), unwell appearance (odds ratio 3.4; 95% confidence interval 1.7, 7.0), and hypotension (odds ratio 0.98; confidence interval 0.96, 1.0) were predictive of higher acuity classification. Temperature, heart rate, respiratory rate, and contextual factors were not related to triage classification. Conclusions Several patient-related factors were related to triage classification. However, the finding that temperature and heart and respiratory rates were not related to triage classification was troubling. Our findings point to a need for enhanced education for triage nurses regarding the physiological indices of sepsis. The sensitivity of the Canadian Triage Assessment Scale, used in Canadian Emergency Rooms, also needs to be examined.

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