Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System

  • Seyedhossein Seyedhosseini-Davarani Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran http://orcid.org/0000-0002-0929-1524
  • Elham Hesari Department of Emergency Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Afzalimoghadam Pre-Hospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. http://orcid.org/0000-0002-3512-4746
  • Javad Seyedhosseini Pre-Hospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. http://orcid.org/0000-0002-9131-9732
  • Nader Tavakoli Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran http://orcid.org/0000-0002-5767-7771
  • Hooman Hossein-Nejad Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-2859-8740
Keywords: Education, Emergency Department, Outcome Assessment, Reproducibility of Results, Triage

Abstract

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity.

Downloads

Download data is not yet available.

References

1. Triage. Available from: https://en.wikipedia.org/wiki/Triage.
2. Dong SL, Bullard M. Emergency department triage. Evidence-Based Emergency Medicine. 2009:58-65.
3. Andreatta PB, Maslowski E, Petty S, Shim W, Marsh M, Hall T. Virtual reality triage training provides a viable solution for disaster-preparedness. Acad Emerg Med. 2010;17(8):870-6.
4.Baratloo A, Maleki M. Iranian emergency department overcrowding. J Emerg Prac Trauma. 2015;1(2):39.
5. Arhami Dolatabadi A, Maleki M, Memary E, Kariman H, Shojaee M, Baratloo A. The use of emergency department services for non-emergency conditions. HealthMED. 2017;11(1):3-9.
6. Kennedy K, Aghababian RV, Gans L, Lewis CP. Triage: techniques and applications in decisionmaking. Ann Emerg Med. 1996;28(2):136-44.
7. Safari S, Rahmati F, Baratloo A, Motamedi M, Forouzanfar MM, Hashemi B, et al. Hospital and pre-hospital triage systems in disaster and normal conditions; a review article. Iran J Emerg Med. 2015;2(1):2-10.
8. Robertson-Steel I. Evolution of triage systems. Emerg Med J. 2006;23(2):154-5.
9. McHugh M, Tanabe P, McClelland M, Khare RK. More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. Acad Emerg Med. 2012;19(1):106-9.
10. Moll HA. Challenges in the validation of triage systems at emergency departments. J Clin Epidemiol. 2010;63(4):384-8.
11. Bruijns SR, Louw P, Kuiler A, Esterhuyse E, Magerman Y. Standardised training is the key to accuracy in triage. S Afr Med J. 2017;107(7):1194.
12. Izumida K, Kato R, Shigeno H, editors. A Triage Training System Considering Cooperation and Proficiency of Multiple Trainees. International Conference on Collaboration Technologies; 2017: Springer.
13. Hammad K, Peng L, Anikeeva O, Arbon P, Du H, Li Y. Emergency nurses’ knowledge and experience with the triage process in Hunan Province, China. Int Emerg Nurs. 2017;35:25-29.
14. Jordi K, Grossmann F, Gaddis GM, Cignacco E, Denhaerynck K, Schwendimann R, et al. Nurses’ accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals. Scand J Trauma Resusc Emerg Med. 2015;23:62.
15. Wolf L. The use of human patient simulation in ED triage training can improve nursing confidence and patient outcomes. J Emerg Nurs. 2008;34(2):169-71.
16. Hagino M, Tayama Y, Okada K-I, editors. A triage training system with dynamic scenario change. Advanced Information Networking and Applications (AINA), 2015 IEEE 29th International Conference on; 2015: IEEE.
17. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med. 2010;17(3):238-43.
18. Brosinski CM, Riddell AJ, Valdez S. Improving Triage Accuracy: A Staff Development Approach. Clin Nurse Spec. 2017;31(3):145-8.
Published
2019-06-18
How to Cite
Seyedhosseini-Davarani, S., Hesari, E., Afzalimoghadam, M., Seyedhosseini, J., Tavakoli, N., & Hossein-Nejad, H. (2019). Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System. Advanced Journal of Emergency Medicine. https://doi.org/10.22114/ajem.v0i0.127
Section
Original article