Kassa Belayneh Dessie, Libanos Mebratu, Geta Kumlachew, Moges Natnael
Department of Emergency and Critical Care Medicine, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Internal Medicine, Debre Tabor University, Debre Tabor, Ethiopia.
Afr J Emerg Med. 2024 Dec;14(4):506-511. doi: 10.1016/j.afjem.2024.10.001. Epub 2024 Dec 7.
In an emergency room, triage is a crucial element that determines the clinical urgency of patients. Triage can dictate important decisions on the use of resources and the treatment that patients need. Many patients are seen later than necessary, wasting resources and time, and some may even be discharged without being seen, risking their lives. This study aimed to determine whether the triage tool was fully completed, properly measured, and documented, the triage early warning score (TEWS) was calculated, and whether patients were examined, distributed, and managed in appropriate areas.
An institution-based cross-sectional study with a retrospective chart review was conducted at Debre Tabor Comprehensive Specialized Hospital by selecting patients' charts using simple random sampling among patients who visited the adult Emergency Department from January 1, 2021, to December 31, 2023. The descriptive statistics were presented to characterize individual variables, and cross-tabulation was used to see the relationship between individual patient-related factors and their final triage status.
From the randomly selected 345 patients' charts, 67 (19.4 %) didn't contain a triage sheet. The total triage early warning score was correctly calculated for only 21 (7.6 %) patients and properly triaged. Most of the patients were improperly triaged (92.4 %, = 257), of which 253 (91 %) were under-triaged and four (1.4 %) were over-triaged. Fischer's exact test revealed a statistically significant relationship between patients' color-coding category, triage early warning score documentation, and the use of clinical discriminators and final triage assessment (p = 0.007, p = 0.000, and p = 0.000 respectively).
The status of our triage implementation is alarming and specifically the level of under-triage. There is a significant gap regarding the application of clinical discriminators and TEWS calculations.
在急诊室，分诊是确定患者临床紧急程度的关键要素。分诊能够决定资源使用和患者所需治疗的重要决策。许多患者就诊时间晚于必要时间，浪费了资源和时间，有些患者甚至未经诊治就被放走，危及生命。本研究旨在确定分诊工具是否填写完整、测量准确并记录在案，分诊早期预警评分（TEWS）是否计算正确，以及患者是否在合适区域接受检查、分流和管理。
在德布雷塔博尔综合专科医院开展了一项基于机构的横断面研究，并进行回顾性病历审查，通过简单随机抽样从2021年1月1日至2023年12月31日就诊于成人急诊科的患者中选取病历。采用描述性统计来描述个体变量，并使用交叉列表来观察个体患者相关因素与其最终分诊状态之间的关系。
在随机抽取的345份患者病历中，67份（19.4%）没有分诊单。仅21名（7.6%）患者的总分诊早期预警评分计算正确且分诊恰当。大多数患者分诊不当（92.4%，n = 257），其中253名（91%）分诊不足，4名（1.4%）分诊过度。费舍尔精确检验显示，患者的颜色编码类别、分诊早期预警评分记录以及临床鉴别指标的使用与最终分诊评估之间存在统计学显著关系（分别为p = 0.007、p = 0.000和p = 0.000）。
我们分诊实施的状况令人担忧，尤其是分诊不足的程度。在临床鉴别指标的应用和TEWS计算方面存在显著差距。
