Ming Thomas, Lai Aaron, Lau Pui-Man
United Christian Hospital, Hong Kong (Dr Ming and Ms Lau); and Blue Shield of California, San Francisco (Mr Lai).
Adv Emerg Nurs J. 2016 Jul-Sep;38(3):233-50. doi: 10.1097/TME.0000000000000113.
This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice.
本系统评价作为一项可行性研究开展，旨在改进某地区医院急诊科的分诊服务。鉴于困扰全球急诊科的过度拥挤问题，我们回顾了随机对照试验（RCT）的证据，以确定急诊科团队分诊与单护士分诊相比是否能改善患者流程。我们通过缩短所有急诊科患者的住院时间（LOS）或等待时间（WT）来衡量患者流程的改善情况。采用Cochrane方法，我们检索并评估了比较由急诊科分诊团队评估的患者与在同一地点接受单护士分诊的患者的RCT数据源。提取的数据由2位作者独立审查以确定纳入情况和进行质量评估。至于各研究的偏倚风险，根据RCT的GRADE（推荐分级评估报告、发展与评价）标准对纳入研究的每个结果进行了总体评估。总共识别出2164项研究，基于标题/摘要排除了2106项，剩下58篇文章进行全面评估。四项试验（均为整群RCT）涉及14772名患者（165个群组）符合纳入标准。根据我们的分析，在这些研究中，所有患者的LOS和WT没有统计学上的显著降低或临床相关降低。一项研究将死亡作为一项结果报告：相对风险为0.34（95%CI[0.01,8.24]），这表明团队分诊可能降低死亡率。总体而言，尽管我们未从RCT中找到确凿证据支持使用团队分诊来改善急诊科的患者流程，但这些结果不一定会阻碍有意引入团队分诊以提高分诊护士士气的护理管理者。然而，他们在实施新做法时可能需要考虑经济和组织因素，如资源重新分配和员工接受度。
