Christ Michael, Bingisser Roland, Nickel Christian Hans
Dtsch Med Wochenschr. 2016 Mar;141(5):329-35. doi: 10.1055/s-0041-109126. Epub 2016 Mar 3.
In emergency departments, patients present with different severities of diseases and traumatic injuries. However, patients with severe and life-threatening conditions compete for the same resources such as personal and structure. As a general rule, each patient should receive immediate diagnostic and treatment, independent of his or her severity of disease or traumatic injury. However, an unexpected number of patients presenting to the emergency department at the same time may exceed available resources. Thus, waiting times will occur and management of patients may be impeded. As a consequence, patients with diseases or traumatic injuries with a need for time-critical management, have to be detected at the time of presentation. After categorization, patients have to be prioritized and guided to the correct place of treatment ("triage"). Starting in Australia and the United States, nurse-driven triage systems have been introduced in the emergency departments. Aim of triage is to correctly identify at increased risk of death and guide them to rapid and correct treatment. In Germany, two five-level triage systems have been introduced: Manchester Triage System (MTS) and Emergency Severity Index (ESI). We give an overview of these risk assessment tools and discuss pros and cons. In addition, new options such as "team triage" and a combination with "Early Warning Scores" are reported. In summary, nurse-driven triage is an instrument to improve patient safety in emergency medicine. A structured and systematic triage of patients using validated triage assessment tools are recommended from national and international societies of emergency medicine. Therefore, nurse-driven triage is also a must in Germany.
在急诊科，患者所患疾病和创伤的严重程度各不相同。然而，患有严重及危及生命病症的患者会争夺相同的资源，如人力和设施。一般来说，每位患者都应立即接受诊断和治疗，不论其疾病或创伤的严重程度如何。然而，同一时间出现在急诊科的患者数量意外增多，可能会超出可用资源。因此，等待时间将会出现，患者的治疗管理可能会受到阻碍。所以，对于需要进行时间紧迫治疗的疾病或创伤患者，必须在就诊时予以识别。分类之后，患者必须被确定优先次序，并被引导至正确的治疗地点（“分诊”）。从澳大利亚和美国开始，护士主导的分诊系统已在急诊科推行。分诊的目的是正确识别死亡风险增加的患者，并引导他们接受快速且正确的治疗。在德国，已引入了两种五级分诊系统：曼彻斯特分诊系统（MTS）和急诊严重程度指数（ESI）。我们将概述这些风险评估工具，并讨论其优缺点。此外，还报告了诸如“团队分诊”以及与“早期预警评分”相结合等新的方式。总之，护士主导的分诊是提高急诊医学患者安全性的一种手段。国内外急诊医学学会建议使用经过验证的分诊评估工具对患者进行结构化、系统化的分诊。因此，护士主导的分诊在德国也是必不可少的。
