Patel Vimla L, Gutnik Lily A, Karlin Daniel R, Pusic Martin
Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University Medical Center, New York, NY 10032, USA.
Adv Health Sci Educ Theory Pract. 2008 Nov;13(4):503-20. doi: 10.1007/s10459-007-9062-6. Epub 2007 Mar 16.
Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.
分诊是急诊科患者评估的第一步，发生在一个高度动态的环境中，该环境在时间、物理空间以及可能超出可用资源的患者需求的限制下运作。通过分诊，利用一部分诊断信息将患者归入有限的几个类别之一。为便于开展这项工作并使分诊决策过程标准化，已实施了分诊指南。然而，经验丰富的（专家级）护士和经验不足的（新手）护士对这些规程的解读有所不同。本研究调查了分诊过程；影响分诊决策的因素，以及在该过程中如何使用指南。通过对分诊护士进行观察和半结构化访谈，在加拿大一家大型教学医院的儿科急诊科收集了数据。结果显示，在紧急情况下：（1）分诊决策通常是非分析性的且基于直觉，尤其是随着专业知识的增加；（2）护士在分诊过程中对指南的使用方式不同。这些结果表明，随着护士积累经验，明确的指南信息会被内化并在紧急分诊实践中被隐性使用。讨论了这些结果对护理教育与培训以及急诊护理指南制定的影响。
