Swedish Emergency Department Triage and Interventions for Improved Patient Flows: a National Update

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2011 Dec 14

PMID 22151969

Citations 26

Authors

Nasim Farrokhnia

Katarina E Goransson

Affiliations

Soon will be listed here.

Abstract

Background: In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden.

Methods: In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows.

Results: Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray.

Conclusions: There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

Citing Articles

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References

Forsgren S, Forsman B, Carlstrom E . Working with Manchester triage -- job satisfaction in nursing. Int Emerg Nurs. 2009; 17(4):226-32. DOI: 10.1016/j.ienj.2009.03.008. View

van der Wulp I, van Baar M, Schrijvers A . Reliability and validity of the Manchester Triage System in a general emergency department patient population in the Netherlands: results of a simulation study. Emerg Med J. 2008; 25(7):431-4. DOI: 10.1136/emj.2007.055228. View

Moller M, Fridlund B, Goransson K . Patients' conceptions of the triage encounter at the Emergency Department. Scand J Caring Sci. 2010; 24(4):746-54. DOI: 10.1111/j.1471-6712.2010.00772.x. View

Goransson K, Ehrenberg A, Ehnfors M . Triage in emergency departments: national survey. J Clin Nurs. 2005; 14(9):1067-74. DOI: 10.1111/j.1365-2702.2005.01191.x. View

Gottschalk S, Wood D, DeVries S, Wallis L, Bruijns S . The Cape Triage Score: a new triage system South Africa. Proposal from the Cape Triage Group. Emerg Med J. 2006; 23(2):149-53. PMC: 2564045. DOI: 10.1136/emj.2005.028332. View

Goransson K, von Rosen A . Interrater agreement: a comparison between two emergency department triage scales. Eur J Emerg Med. 2010; 18(2):68-72. DOI: 10.1097/MEJ.0b013e32833ce4eb. View

Gilboy N, Travers D, Wuerz R . Re-evaluating triage in the new millennium: A comprehensive look at the need for standardization and quality. J Emerg Nurs. 1999; 25(6):468-73. DOI: 10.1016/s0099-1767(99)70007-3. View

Martins H, Cuna L, Freitas P . Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital. Emerg Med J. 2009; 26(3):183-6. DOI: 10.1136/emj.2008.060780. View

Kantonen J, Kaartinen J, Mattila J, Menezes R, Malmila M, Castren M . Impact of the ABCDE triage on the number of patient visits to the emergency department. BMC Emerg Med. 2010; 10:12. PMC: 2889933. DOI: 10.1186/1471-227X-10-12. View

10.

Elshove-Bolk J, Mencl F, van Rijswijck B, Simons M, Van Vugt A . Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department. Emerg Med J. 2007; 24(3):170-4. PMC: 2660021. DOI: 10.1136/emj.2006.039883. View

11.

Rutschmann O, Kossovsky M, Geissbuhler A, Perneger T, Vermeulen B, Simon J . Interactive triage simulator revealed important variability in both process and outcome of emergency triage. J Clin Epidemiol. 2006; 59(6):615-21. DOI: 10.1016/j.jclinepi.2005.11.003. View

12.

Janssen M, van Achterberg T, Adriaansen M, Kampshoff C, Mintjes-de Groot J . Adherence to the guideline 'Triage in emergency departments': a survey of Dutch emergency departments. J Clin Nurs. 2011; 20(17-18):2458-68. DOI: 10.1111/j.1365-2702.2011.03698.x. View

13.

Goransson K, von Rosen A . Patient experience of the triage encounter in a Swedish emergency department. Int Emerg Nurs. 2010; 18(1):36-40. DOI: 10.1016/j.ienj.2009.10.001. View

14.

Grossmann F, Nickel C, Christ M, Schneider K, Spirig R, Bingisser R . Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med. 2010; 57(3):257-64. DOI: 10.1016/j.annemergmed.2010.07.021. View

15.

FitzGerald G, Jelinek G, Scott D, Gerdtz M . Emergency department triage revisited. Emerg Med J. 2010; 27(2):86-92. DOI: 10.1136/emj.2009.077081. View

16.

Goransson K, Ehnfors M, Fonteyn M, Ehrenberg A . Thinking strategies used by Registered Nurses during emergency department triage. J Adv Nurs. 2008; 61(2):163-72. DOI: 10.1111/j.1365-2648.2007.04473.x. View

17.

Olofsson P, Gellerstedt M, Carlstrom E . Manchester Triage in Sweden - interrater reliability and accuracy. Int Emerg Nurs. 2009; 17(3):143-8. DOI: 10.1016/j.ienj.2008.11.008. View

18.

Fernandes C, Tanabe P, Gilboy N, Johnson L, McNair R, Rosenau A . Five-level triage: a report from the ACEP/ENA Five-level Triage Task Force. J Emerg Nurs. 2005; 31(1):39-50. DOI: 10.1016/j.jen.2004.11.002. View

19.

Widgren B, Jourak M . Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2008; 40(6):623-8. DOI: 10.1016/j.jemermed.2008.04.003. View

20.

Ekwall A . Acuity and anxiety from the patient's perspective in the emergency department. J Emerg Nurs. 2013; 39(6):534-8. DOI: 10.1016/j.jen.2010.10.003. View