The Establishment Of The Emergency Triage Scale

ObjectiveTo structure unified, scientific and quantized emergency triage scale to provide the reference standard for triage nurses in the emergency department.Methods1 Literature and national standards review:to understand the research and development of emergency triage scale at home and abroad, to form the frame of the emergency triage and initial item pool.2 Retrospective data analysis:Emergency triage cases of Emergency Administration System were extracted retrospectively from January 1,2014 to December 31,2014. Then the acuity triage level of all extracted cases was assigned according ESI.200 cases of every acuity level (I-V) were selected randomly, then the MEWS/SEWS/NEWS scores were recorded. Fisher Distinction method was used to analyze the relationship between ESI acuity level and EWS scores, cross-validation was used to estimate misjudgment of the model.3 Delphi expert consultation:The single objective indicator, critical sign/situation indicator and response time of all acuity levels were determined by two rounds consultation of 45 experts using Delphi.Results1 Define the structure frame of the emergency triage scale, and the concept and connotation of the single objective indicator, critical sign/situation indicator items.2 Fisher Distinction method was established while ESI (Ⅰ-Ⅴ) was considered as classification variable, and 3 kinds of EWS were independent variable respectively. All Distinction methods were significant statistically by Wilk’s λ test. The prediction misjudgment rate of Emergency triage level for MEWS+SpO2(29.3%) was lower than MEWS(34.4%), SEWS(47.5%) and NEWS(42.0%). The prediction accuracy rate was 93% when combined ESI level Ⅰ and Ⅱ. The corresponding relation between MEWS+ SpO2 and ESI level was Level Ⅰ(≥7points), Level Ⅱ(3-6points),Level Ⅲ(2 points), Level Ⅳ(1 points), Level V(0 points). The corresponding relation between MEWS and ESI level was Level Ⅰ(≥5points), Level Ⅱ(3-4points),Level Ⅲ(2 points), Level IV(1 points), Level Ⅴ(0 points).3 Delphi expert consultation reliability and consistency analysis:questionnaire recovery rate was 100%,97.8% respectively; The expert authority coefficient of two rounds was 0.908,0.909 respectively. The variation coefficient of single objective indicator, critical sign/situation indicator, high risk situation was 0.00-0.19, the coefficient of Kendall’s W of single objective indicator, critical sign/situation indicator, high risk situation after 2 rounds were 0.379,0.388,0.541(p<0.001) respectively, which provide sufficient evidence of high consistency and among experts opinions.4 The emergency triage scale was established, which contained 3 dimensionalities (including single objective indicator, comprehensive indicator and symptom/sign indicator) and 4 primary indicators,29 secondary indicators and 16 tertiary indicators.5 The response time of different acuity level was defined, that was Level 1(0 min), Level Ⅱ(10 min), Level Ⅲ(30min), Level IVa(60min), Level Ⅳb(120min).6 Reassessment time was defined, that was Level Ⅲ(15min), Level Ⅳ (30min).ConclusionThe emergency triage scale was established by literature review, Retrospective data analysis and Delphi expert consultation. It is scientific, reliable and complete, containing 3 dimensionalities. It provides a quantized, acceptable methodology for triage nurse. The response time and reassessment timen were defined to improve the patients’ safety. It also could be the basis of triage training, triage software development and the construction of triage administration standard.