a Emergency Department , University Hospital Center of Liege , Liege , Belgium.
b Medical Simulation Center of Liege , University of Liege , Liege , Belgium.
Scand J Prim Health Care. 2019 Jun;37(2):227-232. doi: 10.1080/02813432.2019.1608057. Epub 2019 Apr 29.
Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON's inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 ( < 0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting.
分诊系统在非工作时间的初级保健医生（PCP）呼叫中已经被经验性地采用，但迄今为止还没有验证过分诊算法。开发了一种名为 SALOMON（Liège 多学科夜间医学定向算法系统）的分诊算法来指导分诊护士。本研究使用模拟 PCP 呼叫评估了该算法的性能。10 名护士参与了 130 个模拟 PCP 呼叫场景，通过比较特定分诊流程图的实际选择和与参考分配相比选择的护理级别，可以确定 SALOMON 的组内一致性。通过比较培训后（T1）和 SALOMON 在临床实践中使用 3 至 6 个月后的分诊（T2），可以评估组内一致性。在 T1 时，流程图的总体选择准确率为 94.1%，在 T2 时为 98.7%。在 T1 时，分诊级别为 93.4%，在 T2 时为 98.5%，分诊级别均为准确。从 T1 到 T2，流程图和分诊级别准确性均显著提高（<0.0001）。在 T1/T2 时，SALOMON 算法的灵敏度和特异性分别为 0.97/0.99。结果表明，护士使用 SALOMON 算法对非工作时间的 PCP 呼叫进行分诊是有效的。该算法的判别效度应通过在实际环境中的实施进一步评估。
