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A Novel Triage for Crowded Emergency Clinics: Patient Triage

Mehmet Husamettin Akkucuk, Meltem Akkas, Nalan Metin Aksu, Evvah Karakilic, Murat Dogan Iscanli, Hayri Ramadan, Yesim Cetinkaya Sardan.

Abstract
More effective and accurate methods of triage are needed for overcrowded emergency clinics. In this study, the starting point was taken as ‘the patient is the primary and most important factor in determining emergency condition’, and thus, the triage was conducted by the patient him/herself. The study involved 308 patients over the age of 16 who were admitted to the Adult Emergency Clinic of Emergency Medicine Department, Hacettepe University Medical School, between May 1st and 9th, 2010. The mean age of the patients was 46 years (SD ± 20.894). Of the patients, 47.9% (n=147) were male, 52.1% (n=160) were female. Considering the complaints of the patients at presentation, and compatibility of diagnosis at triage, Kappa statistics were used and the compatibility rates were as follows: 49.8% in the patients, 41.8% in the paramedics, 63.8% in the nurses, 6.2 % in the intern doctors, 62.6% in the junior residents, 65% in the senior residents, and 66.5% in the specialists. The accuracy rates of prediagnosis based on the patient complaints were 53.1% (n=163) for the patients, 67.1% (n=206) for the paramedics, 71.2% for the nurses, 64.5% (n=198) for the intern doctors, 73% (n=224) for the junior residents, 80.8% (n=248) for the senior residents, and 82.4% (n=253) for the specialists. The overtriage and undertriage rates of the patients were 25.1% and 15.5% respectively, which are compatible with the recommendations by American College of Surgeons Committee on Trauma (ACSCOT). The patients were found successful in establishing the correct triage and diagnosis for themselves. Thus, in cases where the patient him/herself cannot cooperate, experimentation with triage scales developed to involve active participation of patients’ relatives may be helpful. In addition, active participation will significantly reduce the rates of complaints for waiting times and related arguments among patients.

Key words: Overcrowding EDs, triage, self triage, length of stay


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