Who is Really Sick? Eyeball Assessment vs Formal Triage

MedicalResearch.com Interview with:

Dr Anne Kristine Servais Iversen, Anne Kristine Servais Iversen Department of Obstetrics and Gynecology Rigshospitalet Copenhagen, Denmark 

Dr. Servais Iversen

Dr Anne Kristine Servais Iversen,
Anne Kristine Servais Iversen
Department of Obstetrics and Gynecology
Rigshospitalet
Copenhagen, Denmark 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Systematic triage has been implemented worldwide with different triage scales in use all over the world. Prior to the introduction of formalised triage, patients were prioritised based on clinical assumption.

After the introduction of formalised triage only a few studies have assessed agreement between formal and informal triage. Additionally, the majority of formalised triage scales are supported by limited and often insufficient evidence. This is troublesome since formalised triage forces clinicians to follow an algorithm rather than use their experience and clinical judgement. During my own residency at a Danish Emergency ward I was often contacted by the nurse performing formalised triage telling me that a patient she was assessing scored to be very acute (high triage level), but that she didn’t believe that to be the case. In order for her to prioritise the patient to a lower (less acute) triage level the patient had to be assessed by a doctor.

Very often my colleagues and I would agree with the nurse in that the scoring was to high, and we therefore had to overrule the formalised triage decision. In cases like these you ask yourself whether or not we are using the most effective and best form of triage for initial patient sorting.

Our study found that agreement between formalised triage and a quick clinical assessment in the form of Eyeball triage is poor. It also suggest that eyeball triage better predicts those at highest risk of death within 48-hours and 30 days after assessment.

MedicalResearch.com: What should readers take away from your report?

Response:  Simply eyeballing a patient may be more effective than using a formalised triage scale in order to identify those who are the sickest and therefore most in need of urgent medical care.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response:  We believe that the findings from our study indicate that we need new initiatives in order to evaluate triage and optimize initial patient sorting. It would be preferable to perform randomised controlled trials investigating different triage methods with clinically relevant endpoints. Our study also suggests that a simple clinical evaluation should potentially play a larger role in future triage algorithms.

MedicalResearch.com: Is there anything else you would like to add? Any disclosures?

Response: We used a Danish developed triage algorithm (Danish Emergency Process Triage) but with an identical approach to patient sorting as some of the more international established triage scales. Further studies are needed in order to cast more light on this subject.

Citation:

Iversen AKSKristensen MØstervig RM, et al

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