Nurse triage in an accident and emergency department Ramathibodi Hospital: an audit
Bibliographic record
Abstract
Back ground : Triage, the French word, means sorting process. It has been initiated since the First World War and then developed to be the cornerstone to categorize the patients in the emergency department (ED) that the ratio of personal and resource to patients are out off proportion. Triage has been well-developed in many countries that have become the role model such as Australia and New Zealand (Australasian Triage Score: ATS), United Kingdom (Manchester Score) and Canada (Canadian Triage Score). In Thailand, Emergency Medicine has recently been developed, national triage score and also the triage audit havenût been conducted yet. Some ED initiates their own triage system to categorize the patients who visit ED. The aim of this study is to evaluate the validity and concordance of nursing triage and physician triage at Ramathibodi hospital which is the tertiary hospital and the four-level triage system has been used. In addition, we would like to assess the rate of missed evaluation by the nurse and the effect of triage system to patients' admission. Material and Methods : The author carried out a descriptive study by reviewing the patientsû record. The charts were randomly studied between May 1st, 2005 and April 30th, 2006. Results : During the study period, 306 patients who visited ED were enrolled, 146 cases were male (47.7%). The first three most common chief complaints were fever (58, 20%), trauma (56, 19%) and abdominal pain (52, 18%). The concordance between nursing and physician triage was significant correlated (92.8%). The nursing over triage rate was 58.8%. The factor that increase the risk of nursing over triage were the younger patient (OR = 0.988, p-value = 0.026), the patients with GI symptoms (OR = 3.15, p-value = 0.047), trauma patients (OR = 4.78, p-value = 0.003) and the patients who had fever (OR = 8.53, p-value = 0.004). Physician triage had significantly influenced to the patientsû admission (p-value = 0.006). Conclusion : The Ramathibodi four-level triage system was effective; even though there was a significantly different between the nurse and physician triage. However, the concordance between nurse and physician triage was highly correlated. Additionally, the discrepancy can be reduced by establishing a national triage system, nurse training program and periodic reviews of the triage system.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".