Arian Zaboli, Francesco Brigo, Alessandro Cipriano, Serena Sibilio, Gabriele Magnarelli, Norbert Pfeifer, Michele Fratti, Fabio Malalan, Magdalena Massar, Michael Mian, Nicola Pagnucci, Gloria Brigiari, Lorenzo Ghiadoni, Gianni Turcato
{"title":"评估意大利的分诊效率：利用模拟病例对护士进行比较研究。","authors":"Arian Zaboli, Francesco Brigo, Alessandro Cipriano, Serena Sibilio, Gabriele Magnarelli, Norbert Pfeifer, Michele Fratti, Fabio Malalan, Magdalena Massar, Michael Mian, Nicola Pagnucci, Gloria Brigiari, Lorenzo Ghiadoni, Gianni Turcato","doi":"10.1007/s11739-024-03735-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner.</p><p><strong>Methods: </strong>A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes.</p><p><strong>Results: </strong>Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals.</p><p><strong>Conclusion: </strong>There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1167-1176"},"PeriodicalIF":3.2000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.\",\"authors\":\"Arian Zaboli, Francesco Brigo, Alessandro Cipriano, Serena Sibilio, Gabriele Magnarelli, Norbert Pfeifer, Michele Fratti, Fabio Malalan, Magdalena Massar, Michael Mian, Nicola Pagnucci, Gloria Brigiari, Lorenzo Ghiadoni, Gianni Turcato\",\"doi\":\"10.1007/s11739-024-03735-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner.</p><p><strong>Methods: </strong>A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes.</p><p><strong>Results: </strong>Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals.</p><p><strong>Conclusion: </strong>There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.</p>\",\"PeriodicalId\":13662,\"journal\":{\"name\":\"Internal and Emergency Medicine\",\"volume\":\" \",\"pages\":\"1167-1176\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Internal and Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11739-024-03735-z\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11739-024-03735-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.
Background: Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner.
Methods: A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes.
Results: Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals.
Conclusion: There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.
期刊介绍：
Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.
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