Development and Evaluation of a Triage Model Determining the Severity of Outpatients Using the Emergency Severity Index Combined with Early Warning Signs
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Abstract
Abstract: This research and development (R&D) study aimed to develop and evaluate a triage model for determining the severity of outpatients using the Emergency Severity Index (ESI) combined with Early Warning Signs (EWS) of critical conditions. The framework for model development was based on Soukup's evidence-based practice model. The sample included 15 outpatient nurses and medical records of 18 patients who were referred from the outpatient department to the emergency room. Data were collected using instruments including a questionnaire of satisfaction of nurses using the triage model, an assessment form of consistency in triage between outpatient (OPD) nurses and emergency room (ER) nurses, and incidents of patients deteriorating into critical conditions while waiting for examination. Data were analyzed using descriptive statistics. The findings revealed that the developed triage model comprises two main components: 1) the ESI with EWS, including the assessment of respiratory rate, heart rate, oxygen saturation, systolic blood pressure, body temperature, level of consciousness, pain score, and fatigue, and 2) guidelines for patient care. Nurses were highly satisfied score with the developed triage model (Mdn=5, IQR=1. There was an 83.3% consistency in triage between outpatient and ER nurses. Furthermore, no incidents of patient deterioration to a critical condition while they were waiting to be examined at OPD. The results support the continuous use of this triage model by outpatient nurses to enhance patient safety and improve the quality of care.
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References
The Healthcare Accreditation Institute (Public Organization). Hospital and Healthcare Standards. 2nd ed. Nonthaburi: K. Tian Kuang Printing; 2022. Thai.
Digital Technology and Health Information Department SH. Songkhla Hospital Information 2024 Available from: https://skhmis.skhospital.go.th/
Nursing Council of Thailand. Nursing Council of Thailand. Announcement of the Nursing Council on the principles for triaging patients by urgency levels B.E. 2563. The Royal Thai Government Gazette; 2020. p. 34-5. Thai.
Emergency Nurses Association. Emergency Severity Index (ESI) Handbook. 5 ed; 2023.
Department of Medical Services, Ministry of Public Health. MOPH ED. Triage; 2018. Thai.
Wibulpolprasert A. Emergenct Deoartment Triage. In: Tienpratarn W, Angkoontassaneeyarat C, Yuksen C, editors. Complehensive EMERGENCY CARE Guide Book. 2 ed. Bangkok: Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2023. p. 127-32. Thai.
Prasroethsang U, Naruenattanaset N, Namboonruang T. Triage model development outpatient according to the level of emergency severity. Mahasarakham Hospital Journal. 2024; 21(1): 65-75. Thai.
Thesprasit T. Development of a System for Classification of Patients in Outpatient and Emergency Departments at Chokchai Hospital. RHPC9Journal. 2021; 15(36): 160-78. Thai.
Hiranrat P. Development of Nursing Practice Guidelines for Early Warning Sign Surveillance System in High-Risk Patients. 2024; 9(2): 38-47. Thai.
Jantarat P, Rattanaphan P, Kunsete P, et al. Development of Early Warning Sign Model in High-Risk Patient, Songkhla Hospital. Journal of Health Science. 2023; 32(1): 109-19. Thai.
Soukup SM. The center for advanced nursing practice evidence-based practice model: Promoting the scholarship of practice. Nurs Clin North Am. 2000; 35(2): 301-9.
Manangan M. Result of using triage guidelines for emergencies in the Outpatient Department, Chakkarat Hospital, Nakhon Ratchasima Province. Journal of Public Health Nursing. 2020; 34(3): 52-65. Thai.
Supatin N, Kokkrathok N. Efficiency of Outpatient Screening among Registered Nurse, Pak Thong Chai Hospital, Nakhon Ratchasima Province. MJSBH. 2023; 38(3): 595-604. Thai.
Champhunut R, Permpikul C, Pattanasuntorn B. Guidelines for the management of severe sepsis and septic shock (draft): Thai Society of Critical Care Medicine; 2015. Thai.
Magrudthong O, Damkliang J, Mekthat M, et al. Development of nursing model for monitoring and management of sepsis in older adults at emergency room, Hatyai Hospital. TJNMP. 2022; 9(2): 143-62. Thai.
Douw G, Schoonhoven L, Holwerda T, et al. Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: A systematic review. Crit Care. 2015; 19(1): 230.
Torri F, Lopriore P, Montano V, et al. Pathophysiology and management of fatigue in neuromuscular diseases. Int J Mol Sci. 2023; 24(5): 5005. doi: 10.3390/ijms24055005.
Komchadluek. The National Institute for Emergency Medicine has developed a prototype innovation for triage of emergency patients or the Thailand Triage Training Kit (TTTK), for medical personnel to learn for patient triage to meet the same standards 2016. Available from: https://www.komchadluek.net/kom-lifestyle/245402.
Larthum K, Sata R, Paralee P, et al. Development and evaluation of nursing practice guideline in patients with severe traumatic brain injury in the resuscitation room at an accident and emergency department. TJNMP. 2024; 11(1): 20-3. Thai.
Kaisingdeacha W. The Development of a Surveillance Guideline for Deteriorating Patients during Waiting at the Surgical Outpatient Department, Buddhachinaraj Phitsanulok Hospital. Nursing, Health, and Public Health Journal. 2022; 1(1): 40-52. Thai.
Sripetchsai A. Factor affected reliability and quality of emergency patient's triage at Thalang hospital. Science and Technology Northern Journal. 2023; 4(2): 39-58. Thai.
Suphama N, Komwongs S. Effectiveness of the development for emergency patient's triage model at Banfang Hospital, Khon Kaen Province. hej. 2020; 5(4): 65-74. Thai.