The Accuracy of Pediatric Nursing Triage and Its Effectiveness in Reducing the Febrile Convulsion Rate in the Waiting Room

Abstract

Triage has become an integral part of risk management for patients at the Pediatric OPD. After 12 months of its institution, we evaluate the accuracy of nursing triage and its impact on reducing the rate of Febrile Convulsions (FC)occuring in the waiting room at the Pediatric OPD.
Methods : We reviewed the medical records of patients seen in the Pediatric Outpatient Department on 7 random days over a 3-month period. The triage status of the patients was noted and compared to their clinical discharge status. Patients were considered to have "true urgent" discharge status if, during their stay in the OPD, they received emergency interventions such as intravenous hydration, oxygen, or if they were admitted for treatment. The results were entered into contingency table. Records of patients who received treatment for febrile convulsion in the treatment room during the 24-month period from January 2000 to December 2001 were also reviewed. Patients were assigned into the pre or post-triage groups according to if they were seen prior or subsequent to the institution of MTS on May 1, 2001. The episode of FC was considered to have occurred at home if it was noted in the chart or if it was noted that patient had already begun convulsing at the time the patient arrived at the hospital. The difference in febrile convulsion rate occuring in the OPD before and after MTS was instituted was analyzed using a 2 tailed t-test.
Results : There were 806 triage records reviewed. Nursing triage's sensitivity at predicting immediate medical interventions or admissions was 0.79 and specificity was 0.98, with a positive predictive value of 0.67 and a negative predictive value of 0.99. The rate of febrile convulsion occuring in the OPD after the instituion of MTS was found to be significantly less than that occuring before institution of MTS ( p = < 0.001).
Conclusion : The evaluation of our MTS shows that we are able to predict non-urgent triage cases with good accuracy. And the intervention brought on by the triage system helped to decrease the incidence of febrile convulsion seen in the waiting room at the Pediatric OPD.