Arian Zaboli, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Gabriele Magnarelli, Norbert Pfeifer, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gianni Turcato
{"title":"比较标准化与主观分类代码分配护士的安全性和准确性：一项多中心观察模拟研究。","authors":"Arian Zaboli, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Gabriele Magnarelli, Norbert Pfeifer, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gianni Turcato","doi":"10.1111/jocn.17615","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.</p><p><strong>Aim: </strong>To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.</p><p><strong>Design: </strong>A multicenter simulated observational study.</p><p><strong>Methods: </strong>The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.</p><p><strong>Results: </strong>Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.</p><p><strong>Conclusions: </strong>Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.</p><p><strong>Reporting method: </strong>The study was conducted and reported according to the STROBE statement.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter Observational Simulated Study.\",\"authors\":\"Arian Zaboli, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Gabriele Magnarelli, Norbert Pfeifer, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gianni Turcato\",\"doi\":\"10.1111/jocn.17615\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.</p><p><strong>Aim: </strong>To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.</p><p><strong>Design: </strong>A multicenter simulated observational study.</p><p><strong>Methods: </strong>The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.</p><p><strong>Results: </strong>Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.</p><p><strong>Conclusions: </strong>Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.</p><p><strong>Reporting method: </strong>The study was conducted and reported according to the STROBE statement.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>\",\"PeriodicalId\":50236,\"journal\":{\"name\":\"Journal of Clinical Nursing\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-12-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/jocn.17615\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jocn.17615","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter Observational Simulated Study.
Background: Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.
Aim: To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.
Design: A multicenter simulated observational study.
Methods: The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.
Results: Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.
Conclusions: Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.
Reporting method: The study was conducted and reported according to the STROBE statement.
Patient or public contribution: No patient or public contribution.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
