Be careful with triage in emergency departments: Interobserver agreement on 1,578 patients in France

被引：21

作者：

Durand A.-C. ^{[1
]}

Gentile S. ^{[1
]}

Gerbeaux P. ^{[2
]}

Alazia M. ^{[3
]}

Kiegel P. ^{[4
]}

Luigi S. ^{[5
]}

Lindenmeyer E. ^{[6
]}

Olivier P. ^{[7
]}

Hidoux M.-A. ^{[8
]}

Sambuc R. ^{[1
]}

机构：

[1] Laboratoire de Santé Publique, Faculté de Médecine, Equipe de recherche EA 3279 Evaluation hospitalière-Mesure de la santé perçue, Marseille

[2] Service d'Accueil des Urgences, Hôpital de La Conception, Marseille

[3] Service d'Accueil des Urgences, Hôpital Sainte Marguerite, Marseille

[4] Service d'Accueil des Urgences, Hôpital du Pays d'Aix, Aix en Provence

[5] Service d'Accueil des Urgences, Centre Hospitalier Général, Martigues

[6] Service d'Accueil des Urgences, Hôpital Saint Joseph, Marseille

[7] Service d'Accueil des Urgences, Hôpital Henri Duffaut, Avignon

[8] Service d'Accueil des Urgences, Centre Hospitalier Général, Gap

来源：

BMC Emergency Medicine | / 11卷 / 1期

关键词：

Receiver Operating Characteristic Curve; Manage Care Organization; Explicit Criterion; Triage Nurse; Triage Category;

D O I：

10.1186/1471-227X-11-19

中图分类号：

学科分类号：

摘要：

Background: For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED.Methods: We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit.Results: Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43). The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61), gynaecological (kappa = 0.66) and toxicology complaints (kappa = 1.00). The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09) and hospitalization (kappa = 0.20). When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%).Conclusions: The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs. © 2011 Durand et al; licensee BioMed Central Ltd.

引用

共 44 条

[1]

Hoot N.R., Aronsky D., Systematic review of emergency department crowding: causes, effects, and solutions, Ann Emerg Med, 52, pp. 126-136, (2008)

[2]

Lowe R.A., Bindman A.B., Ulrich S.K., Norman G., Scaletta T.A., Keane D., Washington D., Grumbach K., Refusing care to emergency department of patients: evaluation of published triage guidelines, Ann Emerg Med, 23, pp. 286-293, (1994)

[3]

Sempere-Selva T., Peiro S., Sendra-Pina P., Martinez-Espin C., Lopez-Aguilera I., Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons-an approach with explicit criteria, Ann Emerg Med, 37, pp. 568-579, (2001)

[4]

Derlet R.W., Richards J.R., Overcrowding in the nation's emergency departments: complex causes and disturbing effects, Ann Emerg Med, 35, pp. 63-68, (2000)

[5]

Derlet R.W., Nishio D., Cole L.M., Silva J., Triage of patients out of the emergency department: three-year experience, Am J Emerg Med, 10, pp. 195-199, (1992)

[6]

Gentile S., Vignally P., Durand A.C., Gainotti S., Sambuc R., Gerbeaux P., Nonurgent patients in the emergency department? A French formula to prevent misuse, BMC Health Serv Res, 10, (2010)

[7]

Schull M.J., Kiss A., Szalai J.P., The effect of low-complexity patients on emergency department waiting times, Ann Emerg Med, 49, pp. 257-264, (2007)

[8]

Hospital and emergency department overcrowding, Ann Emerg Med, 19, (1990)

[9]

Richardson L.D., Hwang U., Access to care: a review of the emergency medicine literature, Acad Emerg Med, 8, pp. 1030-1036, (2001)

[10]

Durand A.C., Gentile S., Devictor B., Palazzolo S., Vignally P., Gerbeaux P., Sambuc R., ED patients: how nonurgent are they? Systematic review of the emergency medicine literature, Am J Emerg Med, 29, pp. 333-345, (2011)

← 1 2 3 4 5 →