Salk E D, Schriger D L, Hubbell K A, Schwartz B L
UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles; and the Department of Medicine, Division of Emergency Medicine, University of California, San Diego, USA.
Ann Emerg Med. 1998 Dec;32(6):655-64. doi: 10.1016/s0196-0644(98)70063-0.
We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process.
We conducted a 2-phase, prospective, observational study employing a randomized, crossover design in a university teaching hospital emergency department. In both phases, every eligible patient underwent sequential in-person and telephone triage interviews conducted by certified ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetical triage designations and, after being told the patient's vital signs, again selected a designation. Phase 1 designations were based solely on nurses' clinical expertise. In phase 2, both nurses used complaint-based protocols.
Agreement between telephone and in-person designations was poor (percent agreement, 43.1% to 48.8%; kappa,.19 to.26; taub,.34 to.45 for the 4 primary comparisons). Knowledge of vital signs and use of protocols did not improve agreement or increase identification of patients requiring admission to hospital.
These data establish that telephone and in-person triage are not equivalent and suggest that visual cues may play an important role in the triage process. It is unclear whether telephone triage is an adequate method of assigning patients to an appropriate level of care.
我们试图比较面对面访谈和电话访谈得出的分诊类别，并系统地研究视觉线索、生命体征和基于主诉的协议对分诊过程的影响。
我们在一家大学教学医院急诊科进行了一项采用随机交叉设计的两阶段前瞻性观察性研究。在两个阶段中，每一位符合条件的患者都要接受由认证的急诊科分诊护士进行的顺序性面对面和电话分诊访谈。在了解病史后，每位护士从5个假设的分诊类别中选择1个，在得知患者的生命体征后，再次选择一个类别。第一阶段的类别仅基于护士的临床专业知识。在第二阶段，两位护士都使用基于主诉的协议。
电话分诊和面对面分诊类别的一致性较差（一致性百分比为43.1%至48.8%；卡帕值为0.19至0.26；对于4项主要比较，陶布值为0.34至0.45）。生命体征的知识和协议的使用并没有提高一致性，也没有增加对需要住院治疗患者的识别率。
这些数据表明电话分诊和面对面分诊并不等同，并表明视觉线索可能在分诊过程中起重要作用。目前尚不清楚电话分诊是否是将患者分配到适当护理级别的适当方法。
