泰国曼谷诗里拉吉医院儿科分诊的准确性。

Kriengsoontornkij Worapant, Homcheon Busaba, Chomchai Chulathida, Neamsomboon Wipapen

Division of Ambulatory Pediatric, Department ofPediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

J Med Assoc Thai. 2010 Oct;93(10):1172-6.

BACKGROUND

Siriraj Hospital is a busy 2500-bed hospital located in Bangkok, Thailand It has over 1.7 million outpatients, including 120,000 emergency room visits a year, 20,000 of which are pediatric patients. The Pediatric Triage (Pedtriage) system has been in used since the year 2001, but the factors that affect the performance of triage nurse have not been evaluated.

OBJECTIVE

To compare the performance non-pediatric nurses who are responsible for pediatric patients in the emergency room before and after pediatric triage training at Siriraj Hospital.

MATERIAL AND METHOD

Pediatric Triage Training was set up for emergency room and outpatient department nurses between June and October 2006 The training consisted of 5 hours of didactic sessions on the concepts of pediatric triage and 4-5 hour sessions where the nurses were allowed to triage actual pediatric patients under the supervision ofa triage-training nurse. A pre-test and post-test examination was administered. The outcome of triage performance was categorized into under-triage if the patient had an urgent or emergent condition and was triaged as non-urgent, over-triage if a patient had a non-urgent condition and was triaged as urgent or emergent. Statistical description included percent, averages, and standard deviation where appropriate. A standard 4x4 contingency table was used to calculate the sensitivity and specificity. For comparison of performance, a post-hoc analysis was done where the nurses were divided into two groups, those with work experience ofless than or equal to 5 years (group 1) and more than 5 years (group 2). An independent samples t-test was used to determine the difference in performance between the two groups.

RESULTS

Overall, performance on pre-test-post-test differedsignificantly before and after training. The nurses in Group 1 had higher pre-test scores (Group 1 mean = 62.35%, Group 2 mean = 52.41%, p-value = 0.001), were less likely to overtriage (Group 1 mean = 4.11%, Group 2 mean = 6.46%, p-value = 0.021) and had higher specificity oftriage than Group 2 (Group 1 mean = 95.61, Group 2 = 92.39, p-value = 0.019). However, the nurses in Group 2 had more improvement in their post-test scores (percent of improvement from pre-test: Group I mean = 8.56%, Group 2 = 34.69%, p-value = 0.005).

CONCLUSION

Work experience is an important consideration in the triage knowledge and performance of non-pediatric nurses during triage training.

背景

诗里拉吉医院是一家位于泰国曼谷的大型医院，拥有2500张床位，十分繁忙。它每年有超过170万门诊患者，其中包括12万急诊患者，其中2万是儿科患者。儿科分诊（Pedtriage）系统自2001年起开始使用，但影响分诊护士工作表现的因素尚未得到评估。

目的

比较诗里拉吉医院儿科分诊培训前后负责急诊室儿科患者的非儿科护士的工作表现。

材料与方法

2006年6月至10月为急诊室和门诊部护士开展了儿科分诊培训。培训包括5小时关于儿科分诊概念的理论课程，以及4 - 5小时护士在分诊培训护士监督下对实际儿科患者进行分诊的课程。进行了预测试和后测试。分诊表现的结果如果患者有紧急或急症情况却被分诊为非紧急，则分类为分诊不足；如果患者是非紧急情况却被分诊为紧急或急症，则分类为分诊过度。统计描述包括百分比、平均值和适当情况下的标准差。使用标准的4x4列联表计算敏感性和特异性。为了比较表现，进行了事后分析，将护士分为两组，工作经验小于或等于5年的（第1组）和超过5年的（第2组）。使用独立样本t检验来确定两组之间表现的差异。

结果

总体而言，培训前后预测试和后测试的表现有显著差异。第1组护士的预测试分数更高（第1组平均值 = 62.35%，第2组平均值 = 52.41%，p值 = 0.001），分诊过度的可能性更低（第1组平均值 = 4.11%，第2组平均值 = 6.46%，p值 = 0.021），并且分诊的特异性高于第2组（第1组平均值 = 95.61，第2组 = 92.39，p值 = 0.019）。然而，第2组护士的后测试分数提高更多（相对于预测试的提高百分比：第1组平均值 = 8.56%，第2组 = 34.69%，p值 = 0.005）。