A Prospective, Randomized Trial of Emergency Nursing Triage Diagnostic Ordering Guidelines

2.50
Hdl Handle:
http://hdl.handle.net/10755/162954
Type:
Presentation
Title:
A Prospective, Randomized Trial of Emergency Nursing Triage Diagnostic Ordering Guidelines
Abstract:
A Prospective, Randomized Trial of Emergency Nursing Triage Diagnostic Ordering Guidelines
Conference Sponsor:Emergency Nurses Association
Conference Year:2001
Author:Rolniak, Susan, RN, MSN, CRNP, CCRC
Contact Address:343 James Street, Springdale, PA, 15144-1250, USA
Contact Telephone:(412) 232-5827
Co-Authors:Gregory Larkin, MD; David Seaberg, MD; Bruce MacLeod, MD; Kaveh Ilkhanipour, MD; Gail Pupo, MSN, CEN; Michele Buraczewski, RN, MSN, CEN; and Deborah McNamara, RN, BSN
Purpose: The purpose of this study was to measure the impact of nursing triage guidelines on patient satisfaction, throughput time, and cost. Design: This was a prospective, randomized trial comparing nursing triage guidelines to emergency physician ordering practices. Setting/Sample: The study was conducted at an urban, level I emergency department (42,000) annual visits). Patients were randomized to either standard care (control group) or nursing triage diagnostic guidelines (intervention group). Patients in the intervention group had laboratory, radiographic and other common tests ordered prior to physician evaluation according to the complaint driven guidelines. Methodology: The protocols were validated on 357 patients (age 1 month to 89 years). Inter-rater agreement by Cohen?s Kappa was 61% and statistically significant for all radiographs, EKGs, and laboratory tests ordered. The rates for over-ordering were 8% (SD+4%). Protocols were adjusted where there was low inter-rater agreement.
Following validation, 746 patients were included. Of these, 247 (34%) presented with a chief complaint that did not result in order generation, and 71 were lost to follow up. Of 428 remaining patients, 212 were randomized to triage guidelines and 216 were randomized to the control group. Outcomes measured included satisfaction, throughput time, and cost were evaluated. Descriptive statistics, T-test, Kappa and logistic regression were used. Results: Patient satisfaction regarding the waiting time to see a physician improved for the intervention group in low and mid-level acuity areas (lowest acuity intervention: 87% very satisfied vs 25% control; mid-acuity intervention: 67% very satisfied vs 31% control). Patient satisfaction regarding the efficiency of the staff coordinating the care was generally high for both groups (p-NS). Intervention-group patients for extremity injuries, chest pain, abdominal pain (female), and shortness of breath incurred less costs than control-group patients (p<.001). There was a trend towards shorter throughput time for all intervention-group patients which varied according to complaint (combined average throughput times 3.0 hour intervention vs. 5.0 hour control). Conclusions: Triage, diagnostic ordering guidelines resulted in a high rate of inter-observer agreement, low rates of over-ordering, decreased cost, and overall patient satisfaction. Based on the results of this study, these guidelines were implemented in our department and are currently in use. [Research Poster Presentation]
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.titleA Prospective, Randomized Trial of Emergency Nursing Triage Diagnostic Ordering Guidelinesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162954-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Prospective, Randomized Trial of Emergency Nursing Triage Diagnostic Ordering Guidelines</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">2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Rolniak, Susan, RN, MSN, CRNP, CCRC</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">343 James Street, Springdale, PA, 15144-1250, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(412) 232-5827</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">srolniak@bellatlantic.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Gregory Larkin, MD; David Seaberg, MD; Bruce MacLeod, MD; Kaveh Ilkhanipour, MD; Gail Pupo, MSN, CEN; Michele Buraczewski, RN, MSN, CEN; and Deborah McNamara, RN, BSN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The purpose of this study was to measure the impact of nursing triage guidelines on patient satisfaction, throughput time, and cost. Design: This was a prospective, randomized trial comparing nursing triage guidelines to emergency physician ordering practices. Setting/Sample: The study was conducted at an urban, level I emergency department (42,000) annual visits). Patients were randomized to either standard care (control group) or nursing triage diagnostic guidelines (intervention group). Patients in the intervention group had laboratory, radiographic and other common tests ordered prior to physician evaluation according to the complaint driven guidelines. Methodology: The protocols were validated on 357 patients (age 1 month to 89 years). Inter-rater agreement by Cohen?s Kappa was 61% and statistically significant for all radiographs, EKGs, and laboratory tests ordered. The rates for over-ordering were 8% (SD+4%). Protocols were adjusted where there was low inter-rater agreement. <br/>Following validation, 746 patients were included. Of these, 247 (34%) presented with a chief complaint that did not result in order generation, and 71 were lost to follow up. Of 428 remaining patients, 212 were randomized to triage guidelines and 216 were randomized to the control group. Outcomes measured included satisfaction, throughput time, and cost were evaluated. Descriptive statistics, T-test, Kappa and logistic regression were used. Results: Patient satisfaction regarding the waiting time to see a physician improved for the intervention group in low and mid-level acuity areas (lowest acuity intervention: 87% very satisfied vs 25% control; mid-acuity intervention: 67% very satisfied vs 31% control). Patient satisfaction regarding the efficiency of the staff coordinating the care was generally high for both groups (p-NS). Intervention-group patients for extremity injuries, chest pain, abdominal pain (female), and shortness of breath incurred less costs than control-group patients (p&lt;.001). There was a trend towards shorter throughput time for all intervention-group patients which varied according to complaint (combined average throughput times 3.0 hour intervention vs. 5.0 hour control). Conclusions: Triage, diagnostic ordering guidelines resulted in a high rate of inter-observer agreement, low rates of over-ordering, decreased cost, and overall patient satisfaction. Based on the results of this study, these guidelines were implemented in our department and are currently in use. [Research Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:01Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:01Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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