Esmailian Mehrdad, Zamani Majid, Azadi Fatemeh, Ghasemi Faezeh
Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Emerg (Tehran). 2014 Fall;2(4):158-61.
Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time, which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI) system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI.
This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients' triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. To specify the association between the time interval of initial triage and patient final status, Chi-Square test was applied using SPSS 18 statistical software.
There was no significant difference between results of nurses and physicians triage (P<0/0001). The agreement level (kappa index) between two groups was 94% (95% CI: 0.931-0.957). Of 601 patients, 44.1% ones were hospitalized at the emergency department, 52.6% discharged and 3.3% died. The average of time interval between nursing triage and physician visit was 9.55 minutes at the level one triage, 21.64 minutes at level two, 26.03 minutes at level three, 26.93 minutes at level four, and 11.70 minutes at level five.
It seems that there is an acceptable inter-rater agreement between emergency nurses and physicians regarding patients' triage in terms of ESI system.
分诊是患者入院时进行优先级排序的最重要系统之一。基于损伤的严重程度和治疗需求，该系统能在最短时间内对患者进行管理，从而实现患者的高效、安全流转。目前，最被广泛接受的分诊方法是急诊严重程度指数（ESI）系统，它也被视为一种五级分诊方法。2010年3月至5月，伊斯法罕的阿尔扎赫拉医院的经过培训的护士实施了该方法。本研究旨在评估使用ESI进行急诊护理分诊的准确性。
这项前瞻性横断面研究于2010年5月对转诊至伊斯法罕阿尔扎赫拉医院的601例患者进行。分别由医生和护士确定患者的分诊级别，并比较结果。为确定两组之间的一致性水平（评分者间一致性），评估了kappa指数。为明确初始分诊时间间隔与患者最终状态之间的关联，使用SPSS 18统计软件进行卡方检验。
护士和医生的分诊结果之间无显著差异（P<0.0001）。两组之间的一致性水平（kappa指数）为94%（95%CI：0.931 - 0.957）。在601例患者中，44.1%在急诊科住院，52.6%出院，3.3%死亡。一级分诊时护理分诊与医生会诊之间的平均时间间隔为9.55分钟，二级为
