Pointer J E, Levitt M A, Young J C, Promes S B, Messana B J, Adèr M E
Alameda County Emergency Medical Services Agency, Oakland, CA 94607, USA.
Ann Emerg Med. 2001 Sep;38(3):268-77. doi: 10.1067/mem.2001.117198.
We determine whether paramedics, using written guidelines, can accurately triage patients in the field.
This prospective, descriptive study was conducted at an urban county emergency medical services (EMS) system and county hospital. Paramedics triaged patients, for study purposes only, according to 4 categories: (1) needing to come to the emergency department by advanced life support (ALS) transport, (2) needing to come to the ED by any transport, (3) needing to see a physician within 24 hours, or (4) not needing any further physician evaluation. Medical records that provided patient treatment information to the point of ED disposition were subsequently reviewed (blinded to the paramedic rating) to determine which of the categories was appropriate. The protocol of the EMS system of the study site dictates that all patients should be transported except for those who refuse care and leave against medical advice. Only transported patients were included in the present study. Fifty-four paramedics triaged 1,180 patients.
Mean patient age was 43.4+/-17 years; 62.0% were male. Paramedics rated 1,000 (84.7%) of the patients as needing to come to the ED and 180 (15.3%) as not needing to come to the ED. Ratings according to triage category were as follows: 804 (68.1%) category 1, 196 (16.6%) category 2, 148 (12.5%) category 3, and 32 (2.7%) category 4. Seven hundred thirty-six (62.4%) patients were discharged, 298 (25.3%) were admitted, 90 (7.6%) were transferred, 36 (3.1%) left against medical advice, and 20 (1.7%) died. The review panel determined that 113 (9.6%) patients were undertriaged; 55 (48.7%) of these patients were misclassified because the paramedics misused the guidelines. Ninety-nine patients (8.4% of the total sample) were incorrectly classified as not needing to come to the ED. This represented 55% of the patients (99/180) categorized as 3 or 4 by the paramedics. Fourteen patients (1.2% of total) were incorrectly classified as category 4 instead of 3. Of the 113 undertriaged patients, 22 (19.6%) were admitted, 86 (76.1%) were discharged, and 4 (3.5%) were transferred.
Paramedics using written guidelines fall short of an acceptable level of triage accuracy to determine disposition of patients in the field.
我们要确定护理人员依据书面指南能否在现场对患者进行准确分诊。
这项前瞻性描述性研究在一个城市县紧急医疗服务（EMS）系统及县医院开展。仅出于研究目的，护理人员将患者分为4类进行分诊：（1）需要通过高级生命支持（ALS）转运至急诊科；（2）需要通过任何方式转运至急诊科；（3）需要在24小时内看医生；或（4）无需进一步接受医生评估。随后对提供了患者至急诊科处置时治疗信息的病历进行回顾（对护理人员的评级不知情），以确定哪一类分诊是合适的。研究地点的EMS系统方案规定，除拒绝治疗并自行离院的患者外，所有患者均应被转运。本研究仅纳入被转运的患者。54名护理人员对1180名患者进行了分诊。
患者平均年龄为43.4±17岁；62.0%为男性。护理人员将1000名（84.7%）患者评定为需要前往急诊科，180名（15.3%）患者评定为无需前往急诊科。根据分诊类别划分的评级如下：1类804名（68.1%），2类196名（16.6%），3类148名（12.5%），4类32名（2.7%）。736名（62.4%）患者出院，298名（25.3%）患者入院，90名（7.6%）患者转院，36名（3.1%）患者自行离院，20名（1.7%）患者死亡。评审小组确定113名（9.6%）患者分诊不足；其中55名（48.7%）患者分类错误是因为护理人员误用了指南。99名患者（占总样本的8.4%）被错误分类为无需前往急诊科。这占护理人员分类为3类或4类患者的55%（99/180）。14名患者（占总数的1.2%）被错误分类为4类而非3类。在113名分诊不足的患者中，22名（19.6%）入院，86名（76.1%）出院，4名（3.5%）转院。
依据书面指南的护理人员在现场确定患者处置的分诊准确性未达到可接受水平。
