Bakgrund: Akutmottagningar har genom åren fått en större volym av patienter, men vårdutrymmen har inte varit i fas med antal besökare. Patienter upplever att trånga utrymmen och väntetiderna orsakas av underbemanning, tidsbrist eller bristande patientsäkerhet. Akuta händelser kan utlösa övergående stressreaktioner hos involverade och stressbelastningen kan vara så stor att den leder till en posttraumatisk stress reaktion. Syfte: Att skapa en översikt kring sjuksköterskors erfarenheter av sekundär traumatisk stress vid akut omhändertagande av patienter på akutmottagningar. Metod: En allmän litteraturöversikt med sex kvalitativa artiklar och fem kvantitativa artiklar samt en artikel med mixed-method analyseras. En kvalitativ analysmetod användes för att hitta likheter och skillnader i artiklarnas resultat, metod och syfte. Resultat: Sjuksköterskor kunde utveckla sekundär traumatisk stress på grund av organisatoriska faktorer, vårdrelationens faktorer och vårdkulturella faktorer till sekundär traumatisk stress. Dessa kunde leda till utvecklandet av somatiska och psykosomatiska symtom vilket i sin tur påverkade omhändertagandet på akutmottagningen ogynnsamt. Detta kunde även bidra till osäker omvårdnad samt sämre teamsamverkan på grund av kommunikationsbrist. Slutsats: En överidentifiering med patienten eller hög arbetsbelastning ökade risken för utvecklingen på någon form av symtom eller traumatisering vilket kunde medföra att vårdrelationen försämrades eller begränsade patienten från att delta i sin egen omvårdnad. / Background: Emergency departments have received a larger volume of patients, but the care facilities have not been in phase with the increase in the number of visitors. Waiting times are caused by understaffing, lack of time with the patient or patient uncertainty. Acute events can trigger transient stress reactions in those involved and, in some patients, the stress load can be so immence that it leads to a post-traumatic stress reaction. Aim: To create an overview of nurses' experiences of secondary traumatic stress in acute care of patients. Method: A general literature review with six qualitative, five quantitative as well as an article with mixed method is analyzed. Results: development of secondary traumatic stress due to organizational factors, care relationship factors and care cultural factors to secondary traumatic stress was notable. These could lead to the somatic and psychosomatic symptoms, which had a negative impact on the care of patients at the emergency room. This could also contribute to insecure nursing as well as poor team collaboration due to lack of communication. Conclusion: A high workload increased the risk that nurses would develop symptoms or traumatization which could limit patients' participation and cause a care relationship to fail.

Majoriteten av Sveriges akutmottagningar omhändertar såväl vuxna som barn och är bemannade av både allmänsjuksköterskor och specialistsjuksköterskor inom akutsjukvård. Dessa kommer därför att behöva triagera och bedöma akut sjuka och skadade barn trots att de har en begränsad kunskap om barn. Barn ter sig annorlunda än vuxna såväl fysiologiskt som psykologiskt och den kognitiva utvecklingen måste tas i beaktning relaterat till barnens ålder.  Syftet med studien var att belysa triagering eller bedömning av barn inom akutsjukvård.  En allmän litteraturstudie med en systematisk litteratursökning valdes som metod för att svara på syftet. Resultatet är baserat på 15 artiklar som kvalitégranskades, genomgick en integrerad analys och genomarbetades av båda författarna.  I resultatet framkom tre huvudkategorier och nio underkategorier. Resultatet visar på de vanligaste besöksorsakerna och hur barn prioriteras när de söker akutsjukvård. Det visar också på vad som ingår i triageringen och hur kontexten kan komma att påverka triagering eller bedömningen. Det lyfts även faktorer på hur och varför triageringen av barn brister. Barnets inverkan på triageringen är avgörande och att triagera barn skiljer sig från att triagera vuxna. Barnets föräldrar eller vårdnadshavare ska även involveras och kan ha en avgörande inverkan både på barnet och på den som triagerar. Personliga attribut hos den som triagerar spelar en stor roll, både i form av tidigare erfarenhet och utbildning. Många upplever höga krav när det kommer till triagering av barn och teamet spelar en avgörande roll.  Slutsatsen var att triagering och bedömning av barn är en av de svåraste uppgifterna inom akutsjukvården och kräver rätt personal med rätt kompetens och kunskap. Egenskaper hos både barnet, familjen och den som triagerar påverkar utfallet av triageringen och bedömningen. Det är därför bra att ha kännedom om de vanligaste besöksorsakerna, prioriteringsnivå samt hur triagering av barn går till men också när den brister och varför. / The majority of Sweden's emergency departments care for both adults and children and are staffed by both general nurses and specialist nurses in emergency care. These will therefore have to triage and assess acutely ill and injured children, even though they have limited knowledge about children. Children behave differently from adults both physiologically and psychologically and cognitive development must be considered in relation to the children's age.  The aim of the study was to illustrate triage or assessment of children in emergency healthcare.  A literature review with a systematic search was chosen as the method to answer the purpose. The result is based on 15 articles that were quality checked, underwent an integrated analysis, and were elaborated by both authors.  The results revealed three main categories and nine subcategories. The results show the most common reasons for visits and how children are prioritized when seeking emergency medical care. It also shows what is included in the triage and how the context may affect the triage or the assessment. Factors on how and why the triage of children is lacking are also highlighted. The child's impact on triage is crucial and triaging children is different from triaging adults. The child's parents or guardians must also be involved and can have a decisive impact both on the child and on the triage person. Personal attributes of the person triaging play a large role, both in the form of previous experience and education. Many experience high demands when it comes to triaging children and the team plays a crucial role.  The conclusion was that triaging and assessing children is one of the most difficult tasks in emergency healthcare and requires the right staff with the right skills and knowledge. Characteristics of both the child, the family and the person who is triaging affect the outcome of the triage and assessment. It is therefore good to be aware of the most common reasons for visits, level of priority and how triage of children is done, but also when it fails and why.

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)

<p>Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.</p><p>In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.</p><p>The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.</p><p>The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.</p><p>In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.</p>

Η διαλογή (Triage) των ασθενών, που προσέρχονται στο Τμήμα Επειγόντων Περιστατικών (ΤΕΠ), αποτελεί μια διαδικασία, η οποία εφαρμόζεται όταν ο αριθμός των προσερχόμενων πασχόντων είναι μεγαλύτερος από την δυνατότητα του προσωπικού και των διαθέσιμων πόρων του εκάστοτε φορέα. Στην Ελλάδα, η οικονομική ύφεση φαίνεται να έχει επηρεάσει την επισκεψιμότητα στα ΤΕΠ, καθώς υπάρχει ένα τεράστιο ποσοστό του πληθυσμού, που είναι ανασφάλιστοι και που για οποιοδήποτε πρόβλημα υγείας, απευθύνονται στα ΤΕΠ τριτοβάθμιων νοσοκομείων. Ωστόσο, αν και οι ανάγκες απαιτούν ένα πιο ολοκληρωμένο σύστημα ΤΕΠ, τα αποτελέσματα είναι δυσμενή. Η Επείγουσα Ιατρική, αν και είναι νομικά κατοχυρωμένη ειδικότητα σε >54 χώρες παγκοσμίως και σε 19/27 χώρες-μέλη της Ε.Ε., στην Ελλάδα ακόμη δεν είναι αναγνωρισμένη ως ειδικότητα ή εξειδίκευση. Επιπροσθέτως, η διαλογή των ασθενών, δεν είναι οργανωμένη και δεν ακολουθεί τις κατευθυντήριες οδηγίες.. Μόνη εξαίρεση αποτελεί το Γ.Ν. Θεσσαλονίκης ‘Παπαγεωργίου’, στο οποίο εφαρμόζεται διαλογή με 5-level σύστημα, κάνοντας χρήση του αλγορίθμου ESI (Emergency Severity Index). Σκοπός της εργασίας αυτής, αποτελεί αφ' ενός μεν η δημιουργία ενός ευφυούς συστήματος διαλογής και κατηγοριοποίησης των ασθενών, που προσέρχονται στο Τμήμα Επειγόντων Περιστατικών, αφ' ετέρου δε η σύγκριση διαφόρων μεθόδων δημιουργίας του πυρήνα του ευφυούς συστήματος. Στόχος του συστήματος είναι να αποτελέσει ένα χρήσιμο εργαλείο για την αποτελεσματικότερη και ταχύτερη διαλογή των ασθενών. Αρχικά, πραγματοποιήθηκε η συλλογή ενός σημαντικού αριθμού δεδομένων ασθενών, οι οποίοι προσήλθαν στα ΤΕΠ του ΠΓΝ Πατρών. Τα δεδομένα αυτά, τα οποία και συλλέχθηκαν ανώνυμα, περιλαμβάνουν δημογραφικά στοιχεία, το κύριο σύμπτωμα του ασθενή, την αξιολόγηση TRIAGE, τον τρόπο άφιξης στα ΤΕΠ καθώς και ένα σύνολο από χαρακτηριστικά γνωρίσματα για κάθε ξεχωριστό οργανικό σύστημα. Παράλληλα, πραγματοποιήθηκαν συνεντεύξεις με εμπειρογνώμονες (ιατρούς-νοσηλευτές). Η γνώση, η οποία πάρθηκε από τα δεδομένα, τις συνεντεύξεις και την βιβλιογραφία αποτέλεσαν την πηγή για την παραγωγή των κανόνων του συστήματος. Η κατηγοριοποίηση των ασθενών, η οποία και στηρίζεται στο σύστημα διαλογής ESI, γίνεται σε κλάσεις εξόδου. Ο αριθμός των κλάσεων εξόδου, είναι 5πλάσιος του αριθμού των ιατρικών ειδικοτήτων. Η αποτελεσματικότητα του συστήματος, αξιολογείται με βάση διεθνώς χρησιμοποιούμενες μετρικές. / The screening (Triage) of patients attending the Emergency Department (ED) is a process which applies when the number of the arriving patients is greater than the ability of the staff and of the resources of each institution. In Greece, the economic downturn seems to have affected the traffic in ED, as there is a huge percentage of the population, who are uninsured and who for any health problem, addressed to the tertiary hospital. However, although needs require a more integrated system of ED, the results are unfavourable. The Emergency Medicine, although legally patented specialty in > 54 countries around the world and in 19/27 countries-members of the EU, in Greece is still not recognized as a specialty or specialization. In addition, the ED-Triage, is not organized and does not follow the guidelines. The only exception is the General Hospital ‘Papageorgiou’ at Thessaloniki, which uses for ED-Triage a 5-level system, using the algorithm ESI (Emergency Severity Index). The purpose of this work is on the one hand, the creation of an intelligent system for sorting and categorization of patients who come to the Emergency Department, and a comparison of various methods of creating the core of intelligent system. The aim of the system is to be a useful tool for better and faster triage of patients. Initially, the collection was a considerable quantity of data by patients who came to the ED of the Universal Hospital of Patras. These data, which were collected anonymously, include demographics, the main symptom of the patient, the evaluation of TRIAGE, how the patient arrival in the ED and a set of features for each separate organic system. At the same time, made interviews with experts (doctors-nurses). Knowledge, which was taken by the data, interviews and literature became the source for the production of the rules of the system. The categorization of patients, which is based on the sorting system, ESI is to output classes. The number of output classes, is 5 times the number of medical specialties. The effectiveness of the system, evaluated by internationally-used metrics.

Abstract Emergency medical services (EMS) are designed to provide prompt response, on-scene treatment and transport for definitive care in patients with acute illness or injury. In recent years, the growing number of missions for non-urgent matters has challenged emergency care to design risk assessment protocols and tools to support decision-making and resource management at both dispatch and on-scene. The present study was designed to examine the efficacy of a criteria based dispatch protocol and National Early Warning Score (NEWS) in the Finnish EMS system. In addition, the aim of the research was to obtain data on patient allocation and mortality in the Northern Finnish population. The study data included 13,354 EMS missions from a six-month cohort (1.1.2014 - 30.6.2014) of prehospital emergency patients in two hospital districts – Kainuu and Länsi-Pohja – in Northern Finland, using a retrospective, observational design. Prehospital data including patient clinical physiological variables were combined with the national Finnish registries (Care Registry for Health Care, Intensive Care Consortium Database and Cause of Death Registry) in order to examine risk assessment in EMS and prehospital patient outcomes. Based on the result, the risk assessment at the dispatch was correct in 67.5% of the cases and four out of ten EMS missions did not lead to transportation by an ambulance. The use of the Finnish dispatch protocol resulted in an overall rate of 23% of over-triage and a 9% rate of under-triage. The highest NEWS category showed a good sensitivity for 1-day mortality but failed to adequately discriminate patients in need of intensive care or who died within 30-days in a large, unselected, typical EMS population. In conclusion, the criteria based dispatch protocol resulted in over-triage of a quarter of missions and in a significant rate of EMS missions without ambulance transportation. In addition, the predictive value of prehospital NEWS regarding the patient´s risk of death and need for intensive care was low. / Tiivistelmä Ensihoitopalvelu on suunniteltu tarjoamaan nopeaa vastetta, paikalla tapahtuvaa hoitoa ja kuljetusta lopulliseen hoitopaikkaan potilaille, joilla on akuutti sairaus tai vamma. Viime vuosien lisääntyneet yhteydenotot ei-kiireellisissä asioissa on johtanut riskinarviotyökalujen kehittämiseen tukemaan päätöksentekoa ja resurssienhallintaa hätäpuhelun aikana ja tapahtumapaikalla. Tässä tutkimuksessa tarkasteltiin kriteeripohjaista hätäpuhelun käsittelyä sekä varhaisen varoituspistejärjestelmän (NEWS) tehokkuutta suomalaisessa ensihoitojärjestelmässä. Lisäksi tutkimuksen tavoitteena oli saada tietoa ensihoitopotilaiden hoitotuloksista ja kuolleisuudesta Pohjois-Suomessa. Tutkimukseen sisältyi 13 354 ensihoitotehtävää kuuden kuukauden kohortista (1.1.2014 – 30.6.2014) kahden sairaanhoitopiirin alueelta – Kainuu ja Länsi-Pohja – Pohjois-Suomessa käyttämällä retrospektiivistä havainnoivaa tutkimusmenetelmää. Ensihoidon aikana kerätty tieto, mukaan lukien potilaan kliiniset fysiologiset arvot, yhdistettiin kansallisiin rekistereihin (hoitoilmoitusrekisteri, tehohoitokonsortion laatutietokanta sekä kuolinsyyrekisteri) jotta ensihoitopotilaiden riskinarviota ja hoitotuloksia voitiin tutkia. Tutkimustulosten mukaan 67.5 prosentissa tapauksista riskinarvio hätäkeskuksessa oli oikea ja neljä kymmenestä ensihoitotehtävästä ei johtanut kuljetukseen ambulanssilla. Suomalaisen hälytysprotokollan käyttö johti yliarviointiin 23 prosentissa tapauksista ja aliarviointiin 9 prosentissa tapauksista. Korkeariskin NEWS-luokan herkkyys 1-päivän kuolleisuudelle oli hyvä, mutta se ei kyennyt erottelemaan riittävän hyvin potilaita, jotka tarvitsivat tehohoitoa tai kuolivat 30 päivän sisällä suuressa ei-valikoidussa tyypillisessä ensihoitopotilasväestössä. Yhteenvetona todettiin, että kriteeripohjaisen riskinarvion käyttö johti yliarvioon neljänneksestä tapauksista sekä huomattavaan ensihoitotehtävämäärään ilman ambulanssikuljetusta. Lisäksi ensihoidon aikana käytetyn varhaisen varoituspistejärjestelmän ennusteellinen arvo potilaan kuolemanriskin ja tehohoidon tarpeeseen oli matala.

Medical rescue workers are routinely employed in emergency medicine. In emergencies where a large number of people are affected, knowledge of medical disaster practices is necessary. Within a second, the intervening crews should switch to another mode with a different approach to the patients than they use daily. The diploma thesis has set the following goals: to map the level of knowledge of medical rescuers in the field of emergency response with mass health impairment, their personal experience and, last but not least, education and training. Three research questions were asked to reach these objectives. What are the skills of medical rescuers in dealing with emergency health issues with mass health impairment? How do medical rescuers assess incidents with mass health impairment at which they were present and what is their attitude towards training and education in the field of dealing with emergencies with mass health impairment? The research part consists of interviews with two groups of participants: eight medical rescuers of the Medical Rescue Service of the Pardubice Region and the same number of medical rescuers of the Medical Rescue Service of the South Bohemian Region. These interviews supplemented the information provided by the crisis preparedness managers of both medical rescue services. The survey used a qualitative research strategy, conversations were recorded on a dictaphone, then processed into categories, subcategories, tables and evaluated. From the results of the work, a great difference in the knowledge of health rescuers in the field of emergency health problems can be seen. Participants of the South Bohemian Medical Emergency Rescue Service showed shortcomings in both the basic terminology and the solving of extraordinary events in particular, from reporting the situation with a report form to the classification of the disabled. On the contrary, the majority of participants in the Paramedical Rescue Service of the Pardubice Region would be able to file an initial emergency report and categorize and transport patients correctly. On the basis of the evaluated results, this difference in knowledge can be attributed mainly to the frequency and content of the training provided. In the case of South Bohemian participants, we can find the cause in the absence of practical training. The alarming results were noted in the participants' ability to use the START sorting method, from all of the sixteen respondents only one was able to answer there. The elaborated case report of an extraordinary event points to the fact that theoretical shortcomings can subsequently be transferred into practice.

Sjuksköterskor vid Sjukvårdens Larmcentral (SvLC) i Uppsala och Västmanlands län hänvisar regelbundet lågakuta patienter som bedöms inte vara i behov av ambulanssjukvård till alternativa vårdformer. I denna studie kopplades patientdata från SvLC till sjukhusregister för att identifiera patienter som besökte en akutmottagning inom 72 timmar efter en hänvisning vid SvLC. Prevalensen av ett antal utfallsmått undersöktes och logistisk regression användes för att fastställa effekten av ett antal variabler. 20% av hänvisade inringare besökte en akutmottaging inom 72 timmar. Av dessa fick 57% vård på specialistnivå och 37% lades in vid en slutenvårdsenhet. 86% av akutmottagningsbesöken gällde det besvär som patienten kontaktade SvLC för. Äldre patienter hänvisades mindre ofta till alternativa vårdformer, men löpte större risk att kräva vård på specialistnivå och läggas in vid sjukhuset till följd av ett akutmottagningsbesök. Samtal med personer som ringde in flera gånger per månad hänvisades oftare av SvLC än patienter med en kontakt under studiens lopp, medan patienter som ringt in endast ett fåtal gånger besökte akutmottagningen oftare och blev där oftare inlagda. Icke-användning av SvLCs beslutsstöd var vanligare bland hänvisade patienter. Uppdrag som avlsutades utan vidare hänvisning till en annan sjukvårdsinstans resulterade mindre ofta i ett akutmottagningsbesök. Prevalensen av akutmottagningsbesök och inläggningar vid sjukhus efter hänvisning liknar nivån som funnits i andra studier av nordisk prehospital triage. Baserat på resultaten från denna studie föreslås ett antal kvalitetsutvecklingsprojekt samt framtida studier. / Nurses working at the Emergency Medical Dispatch (EMD) centers in the Swedish counties of Uppsala and Västmanland routinely refer patients determined to not require an ambulance to non-emergency care. In this study, hospital records were reviewed to match calls to patients visiting an Emergency Department (ED) within 72 hours of being referred to non- emergency care by an EMD nurse. The prevalence of a number of outcomes was examined, and logistic regression models were used to analyze the effects of several variables of interest. 20% of callers referred to non-emergency medical care visited an ED within 72 hours. Of these, 57% received specialist level care, and 37% were admitted to the hospital. 86% of ED visits were found to be in regards to the condition the patient contacted the EMD for. Elderly patients were less likely to be referred to non-emergency care, but more likely to receive specialist care and be admitted. Very frequent callers were more likely to be referred to non-emergency care, while a moderate rate of contact was associated with increased odds of ED visitation and hospital admission from the ED. Non-utilization of the EMDs’ decision support tool was more common among callers referred to non-emergency care. Calls closed by dispatchers without further referral to other healthcare providers were less likely to result in an ED visit. The prevalence of ED visitations and admissions found in this study are similar to those found in other studies of Scandinavian pre-hospital triage, and a number of possibilities for quality improvement and future studies were identified.

Hintergrund: Triage und Ersteinschätzung von Patienten in der Krankenhaus-Notaufnahme als Instrument der Prozeßgestaltung. Übersicht: In den vergangenen Jahren zeigte sich deutschlandweit ein Trend. Die Versorgung von Patienten in den Notaufnahmen der Krankenhäuser erlangt eine immer größere Bedeutung. Bedeutendste Ressource in der Notaufnahme ist die ärztliche Arbeit. Diagnosestellung und Festlegung der Therapie sind die wesentlichen Leistungen. Es ist entscheidend, die Prozessqualität am Punkt des Erstkontaktes des Notfallpatienten mit dem Krankenhaus zu verbessern. Das Universitätsklinikum Dresden eröffnete 2012 mit der Konservativen Notaufnahme (KNA-S1) eine neue, interdisziplinäre Funktionsstelle. Organisatorische Intervention war die Entlastung und Steuerung der Ressource „Arbeitszeit Arzt“. Es wurde das Manchester Triage System als Steuerungsinstrument implementiert mit den Zielen: • Optimale Nutzung der Infrastruktur • Neu definierter und verbesserter Ablauf der Integration von Notfallpatienten in den Behandlungsprozeß und den Geschäftsprozeß des UKD. • Entwicklung von Handlungsempfehlungen für das Pflegepersonal für Maßnahmen am Patienten vor Arztkontakt Schlussfolgerungen: Die strukturierte Ersteinschätzung von Patienten ist ein zielführendes Instrument, um den organisatorischen Reifegrad des Workflows in der Notaufnahme zu erhöhen. Auf dieser Grundlage entwickelte Handlungsempfehlungen für das Pflegepersonal schaffen für Patienten, Ärzte und Pflegepersonal ein optimiertes, Risiko-reduziertes Umfeld. / Background: Triage and initial assessment of patients in Emergency Departments as organizational tool for process improvement. Summary: A trend occurred throughout Germany during the past years. Hospital Emergency Departments achieve increasing importance in patient care. Crucial resource in the ED is physician´s work and authority for diagnosis and therapy. It is important to improve process quality at the point of emergency patient´s first contact to hospital. In 2012 University Hospital Dresden established a new interdisciplinary infrastructure in emergency care for medical and neurological patients (KNA-S1). Organizational intervention has been to relieve and control workload and schedule of the physicians. The Manchester Triage System was implemented as instrument for process control aiming: • Optimized utilization of resources • improved workflow of how emergency patients are introduced into treatment and hospital workflow • Development of guidelines for nursing staff to accomplish appropriate procedures on patients before seeing the physician first Conclusion: Operating an initial assessment on emergency patients leads to improvement of quality and proficiency throughout the operating procedures of an Emergency Department. Guidelines for nursing staff on this foundation will create an optimized and risk reduced environment for patients, physicians and all medical professionals in the ED.