Does Blood Pressure Measurement Improve the Safety of ESI Triage Algorithm? A Preliminary Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/162529
Type:
Presentation
Title:
Does Blood Pressure Measurement Improve the Safety of ESI Triage Algorithm? A Preliminary Study
Abstract:
Does Blood Pressure Measurement Improve the Safety of ESI Triage Algorithm? A Preliminary Study
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Kiranou, Maria, RN, MSc
P.I. Institution Name:Papegeorgiou Hospital, Nursing Dept., Office of Continuous Education
Title:ED Nurse
Contact Address:West Ring Road, Thessaloniki, 56403, Greece
Contact Telephone:231-069-3161
Co-Authors:Anastasia Tsiviki, RN; Georgios Georgiadis, RN; Athanasia Couta-Chitiri, RN
[Annual Conference Research Poster]
A Preliminary Study.
Thessaloniki, Greece.

Purpose: The measurement of vital signs at triage has been proven beneficial for the safe implementation of Emergency Severity Index (ESI) algorithm. However, Blood Pressure (BP), one of the core vital signs, is not included in the algorithm and not enough justification is provided for this decision in ESI's handbook. The purpose of this preliminary study was to investigate whether not measuring BP at triage could potentially lead to mistriage of critically ill patients. Also, to assess whether emergency nurses agree and thus do not measure BP at triage.

Design: This was a retrospective, observational study.

Setting: The study was conducted at an urban, teaching Emergency Department which is also a Trauma Center.

Sample: Nursing and medical records of adult patients who received care in our ED was conducted. The patients' records were randomly selected between October and December 2008, from six 24-hour shifts.

Methodology: All triage records that had blood pressure documented were reviewed and the following outcome measures were also abstracted: vital signs, triage category, chief complaint, pain presence, nursing and medical interventions, and admission to the hospital. Vital signs were assessed at triage using electronic monitors. Additionally, an external observer used qualitative semi-structured interviews to explore emergency nurses' attitudes related to BP measurement at triage.

Results: Out of 5138 patients that received evaluation at triage, blood pressure was measured in 507 (72 female, 81 male), mean age 65.7 years (34-91). Of the 507 patients, 153 (30 %) had BP higher than 180/100 mmHg (229/150 to 180/80) Other than BP, vital signs were normal in 131 patients indicating triage category 3 according to ESI algorithm. However, our emergency nurses had classified 102 of these 153 patients as triage category 2 (66%) and 51 as triage category 3 (33%). Of the high BP patients, 113 were admitted to the hospital (74%) and only 55 reported pain as their chief complaint (36%). Furthermore, all our triage nurses (34, 100%) reported measuring BP to determine acuity level at critical patients. Twelve of them (35%) also stated that SpO2, Heart Rate, and Respiratory Rate, without BP, is insufficient information for safe triage.

Conclusions: Although ESI does not recommend BP measurement, clinical practice suggests that emergency nurses in certain instances measure and take it into consideration in order to classify patients in acuity categories. When they do so, BP measurement proves to be useful information concerning the patients' need to receive emergency care. When BP is not measured, other vital signs might be normal leading the triage nurse to under-triage the patient. As a result, it would be potentially useful to explore whether ESI algorithm could be supplemented with a list of cases where BP measurement is advised or even add to the algorithm's vital signs BP measurement.
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.titleDoes Blood Pressure Measurement Improve the Safety of ESI Triage Algorithm? A Preliminary Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162529-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Does Blood Pressure Measurement Improve the Safety of ESI Triage Algorithm? A Preliminary Study</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kiranou, Maria, RN, MSc</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Papegeorgiou Hospital, Nursing Dept., Office of Continuous Education</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">ED Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">West Ring Road, Thessaloniki, 56403, Greece</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">231-069-3161</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mkiranou@yahoo.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Anastasia Tsiviki, RN; Georgios Georgiadis, RN; Athanasia Couta-Chitiri, RN</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference Research Poster] <br/>A Preliminary Study.<br/>Thessaloniki, Greece.<br/><br/>Purpose: The measurement of vital signs at triage has been proven beneficial for the safe implementation of Emergency Severity Index (ESI) algorithm. However, Blood Pressure (BP), one of the core vital signs, is not included in the algorithm and not enough justification is provided for this decision in ESI's handbook. The purpose of this preliminary study was to investigate whether not measuring BP at triage could potentially lead to mistriage of critically ill patients. Also, to assess whether emergency nurses agree and thus do not measure BP at triage. <br/><br/>Design: This was a retrospective, observational study. <br/><br/>Setting: The study was conducted at an urban, teaching Emergency Department which is also a Trauma Center. <br/><br/>Sample: Nursing and medical records of adult patients who received care in our ED was conducted. The patients' records were randomly selected between October and December 2008, from six 24-hour shifts. <br/><br/>Methodology: All triage records that had blood pressure documented were reviewed and the following outcome measures were also abstracted: vital signs, triage category, chief complaint, pain presence, nursing and medical interventions, and admission to the hospital. Vital signs were assessed at triage using electronic monitors. Additionally, an external observer used qualitative semi-structured interviews to explore emergency nurses' attitudes related to BP measurement at triage.<br/> <br/>Results: Out of 5138 patients that received evaluation at triage, blood pressure was measured in 507 (72 female, 81 male), mean age 65.7 years (34-91). Of the 507 patients, 153 (30 %) had BP higher than 180/100 mmHg (229/150 to 180/80) Other than BP, vital signs were normal in 131 patients indicating triage category 3 according to ESI algorithm. However, our emergency nurses had classified 102 of these 153 patients as triage category 2 (66%) and 51 as triage category 3 (33%). Of the high BP patients, 113 were admitted to the hospital (74%) and only 55 reported pain as their chief complaint (36%). Furthermore, all our triage nurses (34, 100%) reported measuring BP to determine acuity level at critical patients. Twelve of them (35%) also stated that SpO2, Heart Rate, and Respiratory Rate, without BP, is insufficient information for safe triage. <br/><br/>Conclusions: Although ESI does not recommend BP measurement, clinical practice suggests that emergency nurses in certain instances measure and take it into consideration in order to classify patients in acuity categories. When they do so, BP measurement proves to be useful information concerning the patients' need to receive emergency care. When BP is not measured, other vital signs might be normal leading the triage nurse to under-triage the patient. As a result, it would be potentially useful to explore whether ESI algorithm could be supplemented with a list of cases where BP measurement is advised or even add to the algorithm's vital signs BP measurement.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:44Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:44Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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