Gerdtz Marie F, Chu Matthew, Collins Marnie, Considine Julie, Crellin Dianne, Sands Natisha, Stewart Carmel, Pollock Wendy E
The School of Nursing and Social Work, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
Emerg Med Australas. 2009 Aug;21(4):277-85. doi: 10.1111/j.1742-6723.2009.01197.x.
To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale.
A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance.
A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P<or= 0.001; 65.0%; P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P<or= 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05).
We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.
使用澳大利亚分诊量表，研究护士、患者就诊类型及医院服务水平对分诊一致性的影响。
对调查数据进行二次分析。主要研究旨在测量纳入国家培训项目的237个场景的可靠性。护士从澳大利亚急诊科按同组配额抽样招募。进行分析以确定一致性：即最常见分诊类别中的反应百分比。采用方差分析（anova）和Pearson相关性分析来研究解释变量与一致性之间的关联。
共有42/50（84%）的参与者返回了问卷，提供了9946个场景反应以供分析。在描述患者就诊类型和紧急程度的变量方面，观察到一致性存在显著差异。对照组（成人疼痛；70.7%）的平均得分高于涉及心理健康或妊娠就诊的组（61.4%；P≤0.001；65.0%；P = 0.02）。量表两端的最常见反应高于中间类别（P≤0.001）。根据同组划分，服务类型对一致性有显著的主效应（P = 0.03）。在描述护士特征的九个变量中，年龄是唯一影响结果的因素（P = 0.05）。
我们发现心理健康和妊娠就诊的分诊一致性存在重大问题。需要进一步研究以完善针对这些人群的澳大利亚分诊量表实施指南。
