E D Salk1, D L Schriger, K A Hubbell, B L Schwartz. 1. UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles; and the Department of Medicine, Division of Emergency Medicine, University of California, San Diego, USA.
Abstract
STUDY OBJECTIVES: We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process. METHODS: We conducted a 2-phase, prospective, observational study employing a randomized, crossover design in a university teaching hospital emergency department. In both phases, every eligible patient underwent sequential in-person and telephone triage interviews conducted by certified ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetical triage designations and, after being told the patient's vital signs, again selected a designation. Phase 1 designations were based solely on nurses' clinical expertise. In phase 2, both nurses used complaint-based protocols. RESULTS: Agreement between telephone and in-person designations was poor (percent agreement, 43.1% to 48.8%; kappa,.19 to.26; taub,.34 to.45 for the 4 primary comparisons). Knowledge of vital signs and use of protocols did not improve agreement or increase identification of patients requiring admission to hospital. CONCLUSION: These data establish that telephone and in-person triage are not equivalent and suggest that visual cues may play an important role in the triage process. It is unclear whether telephone triage is an adequate method of assigning patients to an appropriate level of care.
RCT Entities:
STUDY OBJECTIVES: We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process. METHODS: We conducted a 2-phase, prospective, observational study employing a randomized, crossover design in a university teaching hospital emergency department. In both phases, every eligible patient underwent sequential in-person and telephone triage interviews conducted by certified ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetical triage designations and, after being told the patient's vital signs, again selected a designation. Phase 1 designations were based solely on nurses' clinical expertise. In phase 2, both nurses used complaint-based protocols. RESULTS: Agreement between telephone and in-person designations was poor (percent agreement, 43.1% to 48.8%; kappa,.19 to.26; taub,.34 to.45 for the 4 primary comparisons). Knowledge of vital signs and use of protocols did not improve agreement or increase identification of patients requiring admission to hospital. CONCLUSION: These data establish that telephone and in-person triage are not equivalent and suggest that visual cues may play an important role in the triage process. It is unclear whether telephone triage is an adequate method of assigning patients to an appropriate level of care.
Authors: Linda Huibers; Grete Moth; Anders H Carlsen; Morten B Christensen; Peter Vedsted Journal: Br J Gen Pract Date: 2016-07-18 Impact factor: 5.386
Authors: Lee Ellington; Lisa Kennedy Sheldon; Sonia Matwin; Jackie A Smith; Mollie Merkley Poynton; Barbara Insley Crouch; E Martin Caravati Journal: J Emerg Nurs Date: 2008-06-27 Impact factor: 1.836
Authors: Nienke Seiger; Mirjam van Veen; Helena Almeida; Ewout W Steyerberg; Alfred H J van Meurs; Rita Carneiro; Claudio F Alves; Ian Maconochie; Johan van der Lei; Henriëtte A Moll Journal: PLoS One Date: 2014-01-15 Impact factor: 3.240
Authors: Rebecca Lake; Andrew Georgiou; Julie Li; Ling Li; Mary Byrne; Maureen Robinson; Johanna I Westbrook Journal: BMC Health Serv Res Date: 2017-08-30 Impact factor: 2.655