Pre-hospital triage performance and emergency medical services nurse's field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

被引:16
作者
Magnusson, Carl [1 ]
Herlitz, Johan [1 ,2 ]
Axelsson, Christer [1 ,2 ]
机构
[1] Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden
[2] Univ Boras, Pre Hospen Ctr Prehosp Res, Fac Caring Sci Work Life & Social Welf, Boras, Sweden
关键词
Triage; Emergency medical services; Pre-hospital emergency nurse; Field assessment; Patient safety; EARLY WARNING SCORE; SEVERITY INDEX; ACUITY SCALE; NEWS2; SYSTEM; ACCURACY; RISK; CARE; IDENTIFICATION; RELIABILITY;
D O I
10.1186/s13049-020-00766-1
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse's field assessment with the physician's final hospital diagnosis. Methods A prospective, observational study including patients (>= 16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score >= 5, and 3) Classification of pre-hospital nurse's field assessment compared to hospital physician's diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann-Whitney U test and Fisher's exact test, and several binary classification tests were determined. Results Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse's field assessment was appropriate in 84% of these cases. Conclusions In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse's field assessment of time-sensitive conditions was appropriate in the majority of cases.
引用
收藏
页数:15
相关论文
共 50 条
[1]   Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department [J].
Askim, Asa ;
Moser, Florentin ;
Gustad, Lise T. ;
Stene, Helga ;
Gundersen, Maren ;
Asvold, Bjorn Olav ;
Dale, Jostein ;
Bjornsen, Lars Petter ;
Damas, Jan Kristian ;
Solligard, Erik .
SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, 2017, 25
[2]   Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study [J].
Brouns, Steffie H. A. ;
Mignot-Evers, Lisette ;
Derkx, Floor ;
Lambooij, Suze L. ;
Dieleman, Jeanne P. ;
Haak, Harm R. .
BMC EMERGENCY MEDICINE, 2019, 19 (1)
[3]   Do knowledge and experience have specific roles in triage decision-making? [J].
Considine, Julie ;
Botti, Mari ;
Thomas, Shane .
ACADEMIC EMERGENCY MEDICINE, 2007, 14 (08) :722-726
[4]  
Croskerry Pat, 2009, Healthc Q, V12 Spec No Patient, pe171
[5]  
Dalwai MK, 2014, SAMJ S AFR MED J, V104, P372, DOI [10.7196/samj.7604, 10.7196/SAMJ.7604]
[6]   To Transmit or Not to Transmit: How Good Are Emergency Medical Personnel in Detecting STEMI in Patients With Chest Pain? [J].
Ducas, Robin A. ;
Wassef, Anthony W. ;
Jassal, Davinder S. ;
Weldon, Erin ;
Schmidt, Christian ;
Grierson, Rob ;
Tam, James W. .
CANADIAN JOURNAL OF CARDIOLOGY, 2012, 28 (04) :432-437
[7]   Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands [J].
Ebben, Remco H. A. ;
Vloet, Lilian C. M. ;
van Grunsven, Pierre M. ;
Breeman, Wim ;
Goosselink, Ben ;
Lichtveld, Rob A. ;
Mintjes-De Groot, Joke A. J. ;
van Achterberg, Theo .
EUROPEAN JOURNAL OF EMERGENCY MEDICINE, 2015, 22 (03) :199-205
[8]   Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardial infarction: results of an observational study [J].
Feldman, JA ;
Brinsfield, K ;
Bernard, S ;
White, D ;
Maciejko, T .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2005, 23 (04) :443-448
[9]   Five-level triage: A report from the ACEP/ENA five-level triage task force [J].
Fernandes, CMB ;
Tanabe, P ;
Gilboy, N ;
Johnson, LA ;
McNair, RS ;
Rosenau, AM ;
Sawchuk, P ;
Thompson, DA ;
Travers, DA ;
Bonalumi, N ;
Suter, RE .
JOURNAL OF EMERGENCY NURSING, 2005, 31 (01) :39-50
[10]   Emergency department triage revisited [J].
FitzGerald, Gerard ;
Jelinek, George A. ;
Scott, Deborah ;
Gerdtz, Marie Frances .
EMERGENCY MEDICINE JOURNAL, 2010, 27 (02) :86-92