Sammanfattning Syftet var att beskriva skillnader i triagebeslut som förekommer bland olika personalkategorier samt att beskriva olika vitalparametrars betydelser för triage. En ökad belastning finns idag på den prehospitala akutsjukvården. För att fördela resurserna på bästa sätt, att ge vård inom rimlig tid som är nödvändig för patientens tillstånd, har triage införts. Triage innebär att bedöma och prioritera hur snabbt patienten behöver vård. Litteraturstudien hade en deskriptiv design. Vetenskapliga artiklar söktes i PubMed och Cinahl samt utifrån funna artiklars referenslistor. Tio artiklar inkluderades i studien. Det har visat sig att triage har viktig inverkan på patientens fortsatta vård. Det förekom skillnader i beslut beroende på vilken personalkategori som utförde triage. De med högre utbildning triagerade patienterna oftare till rätt avancerad vårdnivå. Ålder och vitalparametrarna andningsfrekvens, saturation och medvetandegrad hade inverkan på triagebeslutet. De patienter som undertriagerades visade på högre mortalitet. För att patientsäkerhet skall uppnås måste all sjukvårdspersonal bedöma patienten till rätt triagenivå för att minska lidande och mortalitet. Det finns en uppenbar vinst i att tidigt upptäcka sviktande vitala organfunktioner och följa hur detta utvecklas. All akutsjukvård, både prehospital och hospital vore förtjänt av ett gemensamt och standardiserat triageinstrument.

Thesis (Ph. D.)--University of Western Australia, 2004.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / In the United States the responsibility to develop criteria for trauma patient’s triage status rests upon individual hospitals rather than the American College of Surgeons. Traumatic injuries from large animals represent a potential need for expanded hospital resources. Urban emergency departments are less likely to regularly see patients with large‐animal related injuries and might be expected to underestimate the predicted injuries. There is scarce research on the topic of initial triage designation for large‐animal related injuries. The aim of this study is to investigate the adequacy of the initial triage designation given to patients presenting with injuries from animals larger than themselves at an urban, safety net, academic Emergency Department and Trauma Center (ACS Level 1 Adult, Level 2 Pediatric). A retrospective chart review was performed on patients presenting to the emergency department (ED) from Jan 2006 until September 2015 with injuries resulting from animals larger than the patient. A total of 213 patients met the inclusion criteria. Our study found that trauma patients injured by large animals who are triaged as low priority have dispositions that are not statistically different from those with higher initial prioritization.

A research report presented to the Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand In partial fulfilment of the degree Master of Science in Medicine (Emergency Medicine) / Background: Private health care emergency departments (EDs) are vital components of health care systems and have become increasingly popular due to their accessibility, convenience and proficiency. This popularity has led to overcrowding which in turn has led to increased patient waiting times. Lengthy waiting times have been shown to be a common cause of patient dissatisfaction. Patients, however, often overestimate the passage of time which results in unwarranted dissatisfaction. Study objectives: The purpose of this study was to establish the actual waiting times experienced by patients from the time of triage to first doctor contact at the Dogwood Hospital Emergency Department. Design: A retrospective cross-sectional descriptive study was undertaken at the Dogwood Hospital Emergency Department from 1 st January 2009 to the 30th August 2009. All patients (adults and children) of all priority who sought medical attention at the Dogwood Hospital ED were included in the study. Main Results: Priority 3 patients waited the longest out of all patients, particularly on weekday mornings. Overall this study revealed that for 70% of patients the triage-to-doctor waiting time was less than 1 hour. Almost 24% of patients waited between one and two hours and about six percent waited more than two hours. Conclusions: Most patients in this study were seen by a doctor within the target times set by the South African Triage Group (SATG). Numerous studies suggest that patients believe that the acceptable triage-to-doctor waiting time is approximately one hour. In this study 30% of patients waited longer than one hour.

This thesis has several aims. The first was to identify how practicing emergency nurses developed themselves personally in educationally in preparation for triage practice. The second was to develop a triage educational program to prepare emergency nurses in triage practice. The third was to evaluate the effectiveness of the triage educational program in increasing participant’s triage knowledge, and the fourth was to develop triage standards for triage education and practice. The research programme was conducted in three stages. The first stage consisted of the development, distribution, analysis and evaluation of a needs analysis questionnaire designed to determine the issues related to a triage education. The second stage of the research applied the needs analysis findings to the development of a 40 hour Triage Educational Program. Stage three added a qualitative dimension to the thesis. The evaluative results supported the quantitative results obtained in the two preceding studies. The Triage Educational Program was not only an effective triage education resource but in addition it was evaluated as effective regardless of one’s previous experience level of triage expertise. / Doctor of Philosophy (PhD)

With the growth of the internet and other media of communication, locating information on the topic of interest is less a problem of finding related documents than determining which particular documents are valuable. Often, the desired information is obscured within a long list of resources. Users become inundated with so much information that the task of sifting through it takes the majority of time on a given information task. Users look at multiple documents at once to find answers to their questions, and switch between documents to get the “complete” picture. New systems are needed that help users cull through related documents to gain the information they need. As a part of the Document Triage Project, we have been looking at ways to help users in sifting through information. The Document Triage Project is developing tools to recognize, represent, communicate, and visualize user interest across applications. The topic of this thesis is recognizing user interest and providing an infrastructure to represent that interest so that it can be shared across the software applications involved in triage. Based on this inferred interest, applications can help users in their triage task by providing visualizations or other functionality. The applications could involve one or many reading interfaces (e.g., a browser, or an editor), an information organizing system (e.g., Visual Knowledge Builder) and search interfaces (the application providing the document collection; e.g., a search engine). To recognize user interest, data is gathered from the user’s reading, navigational and interpretive activities. Algorithms based on statistical models and qualitative analyses of user behavior in triage are used to infer interest. A light-weight infrastructure called Interest Profile Manager has been developed for the representation of interest values and the corresponding metadata. Interest Profile Manager also provides text processing capability, interest analysis functionality, sharing of data across applications and event propagation.

Syftet med studien var att undersöka sjuksköterskornas upplevelser av att arbeta med spotcheck i receptionen, med fokus på patientsäkerheten, dokumentation, den egna kompetensen, användandet av användarstöd samt hur de upplever arbetssituationen vid spotcheck. Spotcheck är en ny arbetsmetod för akutmottagningen på Akademiska Sjukhuset, men har använts på andra akutmottagningar i Sverige sedan en tid tillbaka. Sju sjuksköterskor intervjuades. Intervjuerna transkriberades och analyserades med hjälp av en manifest innehållsanalysmetod av Granheim och Lundman och resulterade i fem kategorier: patientsäkerhet, dokumentation, stöd, kompetens och arbetssituation. I resultatet framkom att sjuksköterskorna upplevde spotcheck som en bra och välfungerande metod som ökade patientsäkerheten. Sjuksköterskorna ansåg att dokumentationen borde vara kortfattad och bara innehålla fakta om sökorsaken. Samarbetet mellan undersköterskor och sjuksköterskor i receptionen upplevdes som viktigt och välfungerande. Flertalet av sjuksköterskorna ansåg att de hade tillräcklig kompetens för att utföra spotcheck. Något användarstöd för hur spotchecken skulle utföras saknades. Negativa upplevelser som framkom var att ingen extra sjukskötersketjänst tillsats för receptionsarbetet samt att nattetid arbetade endast en sjuksköterska i receptionen, de saknade då undersköterska att diskutera med. Slutsatsen är att spotcheck är en välfungerande metod i receptionen. Dock finns brister såsom bristande användarstöd samt personalbrist vilket bör åtgärdas.

Increased patient wait times it the emergency department (ED) have been linked to poor patient outcomes and adverse health care events. The purpose of this quality improvement project was to determine if placing a nurse practitioner (NP) in the triage area would reduce door-to-provider times and improve patient throughput within the ED. The primary question for this quality improvement project was whether the use of NPs in the triage area would improve patient throughput and decrease wait times in the ED. A secondary question identified was if implementing an NP in the triage area would decrease patient length of stay in the ED. Rogers's diffusion of innovations model was used as a theoretical framework for the project. To evaluate the improvement in patient throughput in the ED, data were gathered for 12 months prior to and 12 months after the placement of an NP in the triage area. Data collection included door-to-provider times and door-to-discharge times. Analysis of the data using independent t tests showed no statistically significant reduction in door-to-provider times (p = .278) or overall lengths of stay in the ED (p = .235). There was an overall reduction in door-to-provider times of 11% and a 5% reduction in door-to-discharge times during the intervention. The implications of this project for social change include evidence that NPs are beneficial to the ED when used in the triage area. Based on the findings of this quality improvement project, it is recommended that an NP be placed in the triage area to decrease door-to-provider and door-to-discharge times, and to continue to improve the culture of the ED team to promote the use of NPs within the ED.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (MMed) in the Division of Emergency Medicine. Johannesburg, 2014 / Introduction: Over-triage and access-block are worldwide phenomena which critically compromise patient care and increase morbidity and mortality. Triage is designed to place the patient in the right place at the right time with the right resources. We sought to determine and evaluate the application reliability of the South African Triage Score/Scale (SATS) in adult emergency cases presenting to a central academic hospital and to identify which factors may have influenced this. Methods: Emergency department (ED) triage data for adult patients at a central academic hospital in Johannesburg over a seven day period were captured retrospectively. The investigator applied the SATS 2008 to each triage form. Triage scores and colour banding for the trieur versus the investigator were compared and the overall degree of triage concordance and discordance observed. Results: A total sample size of 1758 cases was recorded. Moderate agreement (quadratically weighted  0.524 at 95%CI 0.450-0.598) for the overall triage banding assignment revealed rates of concordance of 50.6%, discordance of 49.4%, over-triage of 28.5% and under-triage of 20.9%. Tuesday showed the highest patient load with 21.3% of the weekly total. The mean daily and hourly patient loads were 285 and 14 respectively. Time of day analysis showed a daytime predominance of 2/3 of total presentations and a peak hour between 08h00-09h00. Conclusions: The over-triage (28.5%) rate fell within the American College of Surgeons Committee on Trauma’s (ACSCOT) accepted rate of 30-50%, while under-triage (20.9%) exceeded the accepted ACSCOT levels (<10%). When the triage score was calculated and recorded there was improved concordance, interrater reliability and reduced over-triage. The discordance levels of over-triage decreased and under-triage increased respectively with increasing patient acuity. There was no significant correlation between the extent of triage concordance or discordance and patient load.

Bakgrund: Triage är ett hjälpmedel som används för att genomföra bedömningar och prioriteringar av patienter på akutmottagningar. Bedömningarna av patienterna delas upp i olika nivåer beroende efter deras vårdbehov. Syftet med bedömningarna är att se till att den som har störst behov av hjälp erhåller hjälp först. Det är en legitimerad sjuksköterska som utför denna bedömning. Syfte: Beskriva sjuksköterskans erfarenhet av att arbeta med triage på en akutmottagning samt beskriva vilken datasamlingsmetod som använts i de inkluderade artiklarna i resultatet. Metod: En litteraturstudie med deskriptiv design, där tio vetenskapliga artiklar inkluderades. Sökningar efter vetenskapligt material genomfördes i databaserna Cinahl och PubMed samt genom en manuell sökning i de båda databaserna. Artiklarna har granskats för att urskilja skillnader och likheter och sammanställts både i tabellform och i resultattext. Huvudresultat: I Resultatet framkom tre huvudfaktorer som påverkar sjuksköterskors upplevelse av triage: Klinisk erfarenhet, arbetsmiljön på akutmottagningen och teoretisk och praktisk utbildning. Valda artiklars datainsamlingsmetoder bestod av både intervjustudier, enkätstudier, observationsstudier. Slutsatser: Sjuksköterskor beskriver bristande utbildning, avsaknad av yrkeserfarenhet samt olika faktorer som påverkar arbetsmiljön på akutmottagningen som har visat sig ha betydelse för deras erfarenheter av att arbeta med triage. Faktorerna har var och en för sig betydelse för sjuksköterskors yrkesutövning, inte bara inom akutsjukvården, utan även inom andra verksamhetsområden inom sjukvården. Trots den stora variationen av patient tillströmning på akutmottagningar så uppger sjuksköterskor att arbetstillfredsställelsen är stor men om mer vikt lades vid att skapa en godare arbetsmiljö, erbjuda utbildning samt se över kliniska yrkeserfarenhetens betydelse vid triagering kanske arbetstillfredsställelsen skulle vara ännu högre. / Background: Triage is a tool used to carry out assessments and priorities of patients in emergency rooms. The assessment of the patients is divided into different levels according to their health needs. The purpose of the assessments is to ensure that those who have the greatest need of assistance are taken care of first. A registered nurse performs this assessment. Aim: To describe the nurse´s experience working with triage in a emergency department and to describe the data collection method used in the articles included in the result. Method: A literature study with descriptive design, were ten scientific articles were included. A search for scientific material was carried out ant retrieved from the University of Gävle databases Cinahl and PubMed and through a manual search of the two databases. Results: It emerged that nurses describes causes like lack of education, a lack of experience and factors that affect the work environment has been shown to be important for their experience in working with triage. Selected items data collections methods consisted of interview studies, surveys, observational studies and a web-based survey. Conclusion: The results reveled three main factors affecting nurse´s experience of triage: Clinical experience, work environment and education. The factors, each individually is important for nurse’s occupation, not just in emergency care, but also in other areas in healthcare. Despite the great variety influx of patients in emergency rooms the nurse’s professional satisfaction is but if more emphasis was placed on creating a more enjoyable working environment, providing training and reviewing clinical significance of professional experience at the triage then work satisfaction migh be even higher.