Pediatric Telephone Triage Protocols: Standardized Decisionmaking or a False Sense of Security?☆,☆☆,★
Section snippets
INTRODUCTION
Overcrowding in emergency departments, with resulting delays in patient care and increasing numbers of patients leaving without being seen, has underscored the need for more effective systems of triage.1, 2, 3, 4, 5, 6 Cost-containment efforts have also emphasized the need to direct patients away from EDs.7, 8, 9, 10, 11 Various studies have estimated that 11% to 82% of patients presenting to EDs have nonurgent problems that would be more appropriately treated in a less acute setting.12, 13, 14
MATERIALS AND METHODS
A set of commercially available telephone triage protocols25 was evaluated. These protocols direct the triage provider to elicit certain information regarding the patient’s chief complaint, age, symptoms, and medical history. An algorithm based on patient responses eventually leads the triage provider to an endpoint recommending 1 of the following dispositions: (1) call 911; (2) come in to be seen immediately; (3) come in within 24 hours; (4) come in within 48 hours; (5) home care advice. Of
RESULTS
The 12 nurses in our study had means of 13.8 years of nursing experience (range, 3.5 to 24 years); 5 years in the ED (range, 1 to 14.5 years); 8.4 years in pediatrics (range, 1 to 22 years); and 1.58 years of telephone triage experience (range, 0 to 14 years).
The 15 patients had a mean age of 5.4 years (range, 3 days to 16 years). Diagnoses included asthma or reactive airway disease (7 patients), upper respiratory tract infection (3), choking episodes (3), bronchiolitis (1), and cough with
DISCUSSION
Our study of 1 protocol-driven telephone triage system reveals poor correlation among dispositions determined by triage providers presented with a standardized series of cases, despite instructions to follow protocols as closely as possible. Although it is a basic assumption that protocols operate by standardization, our results indicate that nurses did not reliably choose the same protocol in a given case and did not reach the same triage endpoint even when they followed the same protocol.
The
References (39)
- et al.
Triage: Limitations in predicting need for emergent care and hospital admission
Ann Emerg Med
(1996) - et al.
Emergency departments and overcrowding in United States teaching hospitals
Ann Emerg Med
(1991) - et al.
Patients who leave emergency departments without being seen by a physician: Magnitude of the problem in Los Angeles County
Ann Emerg Med
(1994) - et al.
Triage of patients out of the emergency department: Three-year experience
Am J Emerg Med
(1992) “Triaging out” children with minor illnesses from an emergency department by a triage nurse: Where do they go?
J Emerg Nurs
(1995)- et al.
Piloting an evaluation of triage
Int J Nurs Stud
(1992) - et al.
Computerized triage of pediatric patients: Automated triage algorithms
Ann Emerg Med
(1981) - et al.
Computed algorithm-directed triage in the emergency department
Ann Emerg Med
(1989) - et al.
Indigent children who are denied care in the emergency department
Ann Emerg Med
(1990) - et al.
Refusing care to emergency department patients: Evaluation of published triage guidelines
Ann Emerg Med
(1994)
Patients who leave a public hospital emergency department without being seen by a physician
JAMA
Consequences of queueing for care at a public hospital emergency department
JAMA
Ethics of emergency department triage: SAEM position statement
Acad Emerg Med
Emergency room use and primary care case management: Evidence from four Medicaid demonstration programs
Am J Public Health
The impact of outpatient and emergency room use on costs in the Texas Medicaid program
Med Care
The importance of type of usual source of care for children’s physician access and expenditures
Med Care
Diverting managed care Medicaid patients from pediatric emergency department use
Pediatrics
Pediatric nurse triage
Am J Dis Child
The urgency of care need and patient satisfaction at a hospital emergency department
Health Care Manage Rev
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Do we follow triage protocols?
2010, InjuryTesting the safety of after-hours telephone triage: Patient simulations with validated scenarios
2010, Australasian Emergency Nursing JournalAn Examination of Adherence Strategies and Challenges in Poison Control Communication
2009, Journal of Emergency NursingA Bayesian model for triage decision support
2006, International Journal of Medical InformaticsNursing telephone triage and its influence on parents' choice of care for febrile children
2005, Journal of Pediatric NursingTelephone triage performed by emergency room physicians
2005, Anales de Pediatria
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Address for reprints: Judith C Brillman, MD, Department of Emergency Medicine, University of New Mexico School of Medicine, Ambulatory Care Center, 4 West, Albuquerque, NM 87131-5246; 505-272-6524, fax 505-272-6503;E-mail [email protected].
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