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Zaboli A, Ausserhofer D, Sibilio S, Paulmichl R, Toccolini E, Losi C, Giudiceandrea A, Pfeifer N, Brigo F, Turcato G. Nurse triage accuracy in the evaluation of syncope according to European Society of Cardiology guidelines. Eur J Cardiovasc Nurs 2021; 21:280-286. [PMID: 34508636 DOI: 10.1093/eurjcn/zvab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022]
Abstract
AIMS The role of triage for patients admitted to the emergency department (ED) for a syncopal transitory loss of consciousness (TLOC) has not been debated, and no comparisons with the recent European Society of Cardiology (ESC) guidelines are currently available. To verify the ability of triage to correctly prioritize patients with syncopal TLOC. METHODS AND RESULTS All patients who received a triage assessment at the ED of the Merano Hospital (Italy) between 1 January 2017 and 30 June 2019 for a syncope were considered. All syncope were reclassified according to the aetiology reported in the ESC guidelines. The baseline characteristics of the patients were recorded and divided according to the severity code provided during triage into two study groups: high priority (red/orange) and low priority (yellow/green/blue). The outcome of the study was the presence of a diagnosed cardiac cause within 30 days after the admission. A total of 2066 patients were enrolled (14.3% high priority vs. 85.7% low priority). Cardiac syncope was present in 7.5% of patients. Nurse triage showed a sensitivity for cardiac syncope of 44.8%, a specificity of 88.1%, and an accuracy of 84.9%. The observed discriminatory ability presented an area under the receiver operating characteristic curve of 0.685 (95% confidence interval 0.638-0.732). The possible identification of the aetiology of the syncopal TLOC by the nurse showed good agreement with the medical diagnosis (Cohen's kappa 0.857, P < 0.001). CONCLUSIONS In cases of syncopal TLOC, nurse triage had a fair specificity but suboptimal sensitivity for cardiac causes. Specific nursing assessments following triage (e.g. precise scores or electrocardiogram) could improve the triage performance.
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Affiliation(s)
- Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
| | - Dietmar Ausserhofer
- Department of Research, College of Health Care Professions Claudiana, Bolzano-Bozen, Italy.,Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
| | - Rupert Paulmichl
- Department of Cardiology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Elia Toccolini
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
| | - Chiara Losi
- Department of Cardiology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Alberto Giudiceandrea
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012 Merano-Meran, Italy
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Mistry B, Balhara KS, Hinson JS, Anton X, Othman IY, E'nouz MAL, Avila NA, Henry S, Levin S, De Ramirez SS. Nursing Perceptions of the Emergency Severity Index as a Triage Tool in the United Arab Emirates: A Qualitative Analysis. J Emerg Nurs 2017; 44:360-367. [PMID: 29167033 DOI: 10.1016/j.jen.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/23/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION With emergency department crowding becoming an increasing problem across the globe, nursing triage to prioritize patients receiving care is ever more important. ESI is the most common triage system used in the United States and is increasingly used worldwide. This qualitative study that explores emergency nursing perceptions of the ESI identifies strengths, weaknesses, and barriers to implementation of the ESI internationally. METHODS We conducted a cross-sectional qualitative analysis using semistructured interviews of 27 emergency triage nurses. Content analysis was performed by 2 independent coders, using NVivo software to identify and analyze important themes. RESULTS Interview coding revealed 7 core themes related to use of the ESI (frequencies indicated in parentheses): ease of use (90), speed and efficiency (135), patient safety (12), accuracy and reliability (30), challenging patient characteristics (123), subjectivity and variability (173), and effect of triage system on team dynamics (100). Intercoder agreement was excellent (Cohen's unweighted kappa = 0.84). Subjectivity and variability in ESI score assignment consistently emerged in all interviews and included variability in number and use of resources, definition of "high risk," nursing experience, and subjectivity in pain assessment. DISCUSSION Although emergency nurses perceive the ESI as easy to use, there are concerns about the subjectivity and variability inherent in the ESI that can lead to a functional lack of triage and a burden of undifferentiated ESI level 3 patients. These limitations in separating critically ill patients and in stratifying patients based on anticipated required resources points to the need for improvement in the ESI algorithm or a more objective triage system that can predict patient outcomes.
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Affiliation(s)
- Binoy Mistry
- Baltimore, MD; San Antonio, TX; Abu Dhabi, United Arab Emirates.
| | - Kamna S Balhara
- Baltimore, MD; San Antonio, TX; Abu Dhabi, United Arab Emirates
| | | | - Xavier Anton
- Baltimore, MD; San Antonio, TX; Abu Dhabi, United Arab Emirates
| | | | | | | | - Sophia Henry
- Baltimore, MD; San Antonio, TX; Abu Dhabi, United Arab Emirates
| | - Scott Levin
- Baltimore, MD; San Antonio, TX; Abu Dhabi, United Arab Emirates
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Li L, Lake R, Raban MZ, Byrne M, Robinson M, Westbrook J, Baysari MT. Medication-related calls received by a national telenursing triage and advice service in Australia: a retrospective cohort study. BMC Health Serv Res 2017; 17:197. [PMID: 28288619 PMCID: PMC5348865 DOI: 10.1186/s12913-017-2135-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 03/04/2017] [Indexed: 11/29/2022] Open
Abstract
Background Telenursing triage and advice services are increasingly being used to deliver health advice. Medication-related queries are common, however little research has explored the medication-related calls made to these services. The aim of this study was to examine the profile of medication-related calls to a national telenursing triage and advice service and the medications involved. Methods This was a retrospective cohort study of medication-related calls received by Australia’s national helpline (healthdirect helpline) in 2014, which provides free advice from registered nurses. We examined the volume of medication-related calls over time, user profiles for patients and callers, and call characteristics and we also investigated medications involved in the calls by their generic names and therapeutic classes. Results Of 675,774 calls, 3.8% (n = 25,744) were medication-related, which was the largest category of calls. The average call length was 10 min. Over half of callers (55.4%) were advised to deliver self-care. Of 7,459 calls where the callers reported they did not know what to do prior to calling, 56.8% were advised to self-care and 3.5% were transferred to the Poisons Information Centre immediately. Of 1,277 calls where callers reported that they had originally intended to call an ambulance or attend an emergency department (ED), none were advised to do so. Advice most frequently requested was about analgesics and antipyretics, followed by non-steroidal anti-inflammatory agents. Conclusion The telenursing triage and advice helpline offered quick and easily accessible advice, and provided reassurance to patients and callers with medication-related queries. The service also potentially diverted some patients from attending an ED unnecessarily.
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Affiliation(s)
- Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Rebecca Lake
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW, 2109, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW, 2109, Australia
| | - Mary Byrne
- Healthdirect Australia, Sydney, NSW, Australia
| | | | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW, 2109, Australia
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW, 2109, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
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Hong P, Ritchie K, Beaton-Campbell C, Cavanagh L, Belyea J, Corsten G. The effectiveness of nurse-led outpatient referral triage decision making in pediatric otolaryngology. Int J Pediatr Otorhinolaryngol 2015; 79:576-8. [PMID: 25698460 DOI: 10.1016/j.ijporl.2015.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the effectiveness of nurse-led triage of outpatient referrals in an academic pediatric otolaryngology practice. METHODS Three hundred consecutive outpatient referrals were reviewed and triaged by two otolaryngology registered nurses and two attending pediatric otolaryngologists. The nurses received triage training. The referrals were triaged as 'routine' (to be seen within 2-3 months), 'semi-urgent' (to be seen within 6 weeks), or 'urgent' (to be seen within 2 weeks). Weighted Kappa statistics (correcting for chance agreement) were performed to assess for the degree of agreement. After the consultation visits, patient records were reviewed to determine whether any referrals had been inappropriately triaged by the nurses. RESULTS Overall, there was substantial agreement between all raters. Specifically, weighted Kappa statistics were as follows: surgeon 1, nurse 1: 0.708; surgeon 1, nurse 2: 0.670; surgeon 2, nurse 1: 0.762; surgeon 2, nurse 2: 0.647; nurse 1, nurse 2: 0.756; and surgeon 1, surgeon 2: 0.784. Review of patient charts after consultation showed that no referrals were deemed to be inappropriately triaged and no urgent cases had been missed. CONCLUSIONS Our model of nurse-led triage of outpatient referrals was found to be effective and safe. Similar systems may be considered in other areas of medicine as a viable and acceptable alternative to the traditional physician-led triage practice.
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Affiliation(s)
- Paul Hong
- IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada; School of Human Communication Disorders, Dalhousie University, Halifax, NS, Canada.
| | - Krista Ritchie
- IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Lynn Cavanagh
- IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - James Belyea
- IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Gerard Corsten
- IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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