2.50
Hdl Handle:
http://hdl.handle.net/10755/162400
Type:
Presentation
Title:
Accurate Triage Categorization - A Critical Step in Managing Throughput
Abstract:
Accurate Triage Categorization - A Critical Step in Managing Throughput
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Raschke-Deichstetter, Nancy, RN, MSN, CEN
P.I. Institution Name:Edward Hospital
Title:Staff RN Emergency Department
Contact Address:801 S. Washington Street, Naperville, IL, 60540, USA
Contact Telephone:630-527-5737
Co-Authors:Rebecca Steinmann, RN, APN, CEN, CPEN, CCRN, CCNS
[ENA Annual Conference - Research Presentation]
Purpose: The purpose of this study was to determine accuracy of Emergency Severity Index (ESI) categorization at a community hospital. Under-triage is associated with negative patient outcomes whereas over-triage potentially diverts resources needed for higher acuity patients to patients with less immediate needs. Determining the appropriate priority of care and allocating resources accordingly is crucial to effectively managing patient flow in the emergency department (ED).

Design: A retrospective chart review of 241 randomly selected adult ED patients, aged18 years or older, was conducted. A 93.3% researcher inter-rater reliability was established using case studies in the Emergency Severity Index, Version 4: Implementation Handbook. The study received approval from the Hospital Institutional Review Board.

Setting: The institution is a 308-bed suburban, level II trauma center, and designated stroke center located in the Midwest. The ED is a 46- bed unit with an annual census of 68,000 visits.

Participants: All records from adult patients evaluated in the ED during a two-week period in May 2008 were eligible for study inclusion. Age ranged from 19-98 with a mean age of 50.1 years. The sample included 143 female patients (59.3%) and 98 male patients (40.7%).

Methods: Researchers reviewed each chart independently and assigned ESI scores after reading triage documentation. Disputed ESI categorization was determined by an independent third party review. Demographic data included length of stay, disposition, resource utilization, age, and chief complaint.

Results: The sample included 1 (0.4%) ESI level 1, 57 (23.8%) ESI level 2, 120 (50%) ESI level 3, 51 (21.3%) ESI level 4, and 11 (4.6%) ESI level 5. Seventy-three (30.3%) patients were admitted, 65 (68.4%) were discharged, and 2 (.08%) patients left AMA. Resource utilization for each category was 7 for ESI level 1, 4.17 for ESI level 2, 3.14 for ESI level 3, 1 for ESI level 4, and .18 for ESI level 5.
When comparing triage nurse categorization to researcher categorization, the triage nurse tended to categorize patients at a higher ESI level (2.88 vs. 3.06, p =.000). In the sample, 21.7% of patients were over-triaged and 4.6% were under-triaged. The majority of over-triage involved patients presenting with minor musculoskeletal, dermatologic, or ear, nose, and throat complaints. Under-triage most frequently involved older patients (> 65 years of age) with a variety of chief complaints. Data comparing age and ESI revealed that the 65-75 age group was characterized by higher ESI levels, greater resource utilization, and an increased likelihood of admission.

Implications: ESI levels, resource utilization, and length of stay data from this study is comparable to previously published studies, reinforcing the reliability and validity of ESI, version 4 in the adult population. Recognition of the extent of under-and over-triage, and the patient populations most commonly categorized incorrectly, provides an opportunity to focus education to improve triage accuracy. Based on preliminary findings from this study and the aging of the general population, further investigation is needed to determine how age influences ESI and resource utilization.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAccurate Triage Categorization - A Critical Step in Managing Throughputen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162400-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Accurate Triage Categorization - A Critical Step in Managing Throughput</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Raschke-Deichstetter, Nancy, RN, MSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Edward Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff RN Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">801 S. Washington Street, Naperville, IL, 60540, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">630-527-5737</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">nraschke@edward.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Rebecca Steinmann, RN, APN, CEN, CPEN, CCRN, CCNS</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation]<br/>Purpose: The purpose of this study was to determine accuracy of Emergency Severity Index (ESI) categorization at a community hospital. Under-triage is associated with negative patient outcomes whereas over-triage potentially diverts resources needed for higher acuity patients to patients with less immediate needs. Determining the appropriate priority of care and allocating resources accordingly is crucial to effectively managing patient flow in the emergency department (ED).<br/><br/>Design: A retrospective chart review of 241 randomly selected adult ED patients, aged18 years or older, was conducted. A 93.3% researcher inter-rater reliability was established using case studies in the Emergency Severity Index, Version 4: Implementation Handbook. The study received approval from the Hospital Institutional Review Board. <br/><br/>Setting: The institution is a 308-bed suburban, level II trauma center, and designated stroke center located in the Midwest. The ED is a 46- bed unit with an annual census of 68,000 visits. <br/> <br/>Participants: All records from adult patients evaluated in the ED during a two-week period in May 2008 were eligible for study inclusion. Age ranged from 19-98 with a mean age of 50.1 years. The sample included 143 female patients (59.3%) and 98 male patients (40.7%). <br/> <br/>Methods: Researchers reviewed each chart independently and assigned ESI scores after reading triage documentation. Disputed ESI categorization was determined by an independent third party review. Demographic data included length of stay, disposition, resource utilization, age, and chief complaint. <br/> <br/>Results: The sample included 1 (0.4%) ESI level 1, 57 (23.8%) ESI level 2, 120 (50%) ESI level 3, 51 (21.3%) ESI level 4, and 11 (4.6%) ESI level 5. Seventy-three (30.3%) patients were admitted, 65 (68.4%) were discharged, and 2 (.08%) patients left AMA. Resource utilization for each category was 7 for ESI level 1, 4.17 for ESI level 2, 3.14 for ESI level 3, 1 for ESI level 4, and .18 for ESI level 5. <br/>When comparing triage nurse categorization to researcher categorization, the triage nurse tended to categorize patients at a higher ESI level (2.88 vs. 3.06, p =.000). In the sample, 21.7% of patients were over-triaged and 4.6% were under-triaged. The majority of over-triage involved patients presenting with minor musculoskeletal, dermatologic, or ear, nose, and throat complaints. Under-triage most frequently involved older patients (&gt; 65 years of age) with a variety of chief complaints. Data comparing age and ESI revealed that the 65-75 age group was characterized by higher ESI levels, greater resource utilization, and an increased likelihood of admission.<br/> <br/>Implications: ESI levels, resource utilization, and length of stay data from this study is comparable to previously published studies, reinforcing the reliability and validity of ESI, version 4 in the adult population. Recognition of the extent of under-and over-triage, and the patient populations most commonly categorized incorrectly, provides an opportunity to focus education to improve triage accuracy. Based on preliminary findings from this study and the aging of the general population, further investigation is needed to determine how age influences ESI and resource utilization. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:34Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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