Cooper Richelle J, Schriger David L, Flaherty Heather L, Lin Edward J, Hubbell Kelly A
UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, CA, USA.
Ann Emerg Med. 2002 Mar;39(3):223-32. doi: 10.1067/mem.2002.121524.
We sought to determine whether knowledge of vital signs changes nurse triage designations (TDs). We also sought to determine whether patient age and ability to communicate modify the effect of vital signs on triage decisions.
We performed a prospective observational study, in 24 emergency departments, of nurse-assigned TDs of all ED patients undergoing triage. Nurses performed their typical triage routine, except that they chose 1 of 5 hypothetical TDs (call 911, ED <2 hours, physician's office 2 to 8 hours, physician's office 8 to 24 hours, or home care) before and after measurement of vital signs. The main outcome measure was the change of TD after knowledge of a patient's vital signs, with stratification on the basis of patient age and communication barriers. The secondary outcome was the final ED disposition.
Six hundred twenty-five experienced triage nurses at 24 different EDs collected data on 14,285 patients. TDs were downgraded (decreased in urgency) in 2.4% of patients, and 5.5% were upgraded (increased in urgency) after vital signs were known. Changes were more likely to occur in the young (< or = 2 years old; 11.4%) and the elderly (> or = 75 years old; 9.9%) than in those 3 to 74 years of age (7.5%). When nurses reported a communication barrier, a change in post-vital signs TD was also more common (11.2% versus 7.7%). The post-vital signs TD better predicted patient ED disposition.
In this sample, 92.1% of the nurses' TDs were not affected by the knowledge of patient vital signs. For the other 7.9%, including many patients from vulnerable populations, the vital signs changed the nurses' assessments of the patients' triage designation. Methods of triage that do not determine vital signs may not adequately reflect the urgency of the patient's presentation.
我们试图确定生命体征的信息是否会改变护士的分诊类别（TDs）。我们还试图确定患者年龄和沟通能力是否会改变生命体征对分诊决策的影响。
我们在24个急诊科进行了一项前瞻性观察研究，对所有接受分诊的急诊患者进行护士指定的TDs评估。护士们按照他们通常的分诊程序进行操作，只是在测量生命体征前后，他们要从5个假设的TDs中选择1个（呼叫911、急诊<2小时、医生办公室2至8小时、医生办公室8至24小时或家庭护理）。主要结局指标是在知晓患者生命体征后TDs的变化，并根据患者年龄和沟通障碍进行分层。次要结局是最终的急诊处置情况。
24个不同急诊科的625名经验丰富的分诊护士收集了14285名患者的数据。在知晓生命体征后，2.4%的患者TDs被降级（紧急程度降低），5.5%的患者TDs被升级（紧急程度增加）。与3至74岁的患者（7.5%）相比，变化更有可能发生在年轻患者（≤2岁；11.4%）和老年患者（≥75岁；9.9%）中。当护士报告存在沟通障碍时，生命体征测量后的TDs变化也更常见（11.2%对7.7%）。生命体征测量后的TDs能更好地预测患者的急诊处置情况。
在这个样本中，92.1%的护士分诊类别不受患者生命体征信息的影响。对于另外7.9%的患者，包括许多弱势群体中的患者，生命体征改变了护士对患者分诊类别的评估。未确定生命体征的分诊方法可能无法充分反映患者就诊的紧急程度。
