D'autres liens URL Triage First, Inc. www.triagefirst.com Emergency Nursing World http://ENW.org/Solutions.htm
et qqs docs Aust Crit Care 2002 Aug;15(3):119-22Related Articles, Links Nurse-initiated x-ray of isolated limb fractures in the emergency department: research outcomes and future directions. Tambimuttu J, Hawley R, Marshall A. Department of Clinical Nursing, Faculty of Nursing, The University of Sydney, NSW. Patients presenting at emergency departments with isolated limb trauma face chronic delays due to over crowding and over utilisation of these departments for primary health care. Excessive waiting periods for assessment, definitive diagnostic procedures and subsequent treatment plans compound the current access block for emergency care, with these factors contributing to patient dissatisfaction. To improve patient satisfaction and decrease waiting times for some patients, the literature suggests that nurse initiated x-rays at the point of triage may be of value. Nurses can appropriately determine the need for radiological assessment in patients with isolated limb trauma--a high correlation has been found between doctors' and nurses' ordering of x-rays. To ensure x-rays are accurately and appropriately ordered, it is suggested that strict guidelines and structured educational programmes for nurses be implemented. The findings from this literature review suggest that extending the triage role to include nurse initiated x-rays has the potential to decrease waiting times and to increase patient satisfaction in the emergency department. Aust Crit Care 2002 Aug;15(3):103-8Related Articles, Links Balancing values and imperatives: a study of nursing service in an ICU. Gardner GE, Pierce K. Canberra Hospital, University of Canberra Research Centre for Nursing Practice, ACT. There has been significant attention from the managers and purchasers of health services regarding the economic advantages that result from changes to the patterns of health care delivery in the acute hospital setting. The impact of these changes, whilst often rendering advantage at the economic management level of health care, can have different consequences for the people who deliver and the people who receive health service. This paper reports on a study that was conducted with a group of nurses to investigate the practice milieu of a critical care unit in the context of changes to health service management. Interpretive methods were used to capture the perspective of the nurses and the way they interpret the multiple factors that influence their practice and their practice environment. The findings indicate that the nurses in the study setting interpret these factors according to the influences they have on the structure, the geography and the value of their work. Explication of these findings provides a research base to inform recommendations relating to improving the practice milieu of the critical care environment. Chang Gung Med J 2002 Jul;25(7):446-52Related Articles, Links Evaluation of nurse-physician inter-observer agreement on triage categorization in the emergency department of a Taiwan medical center. Loke SS, Liaw SJ, Tiong LK, Ling TS, Chiang WT. Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. [EMAIL PROTECTED] BACKGROUND: To examine nurse-physician inter-observer agreement on triage categorization and analyze their differences for future reference. METHODS: A retrospective observational study was performed. Patients entering a 3500-bed medical center emergency department (ED) from July 1 to 31, 1998 were randomly selected. We compared triage assignments made by nurses and 2 ED physicians, and examined them for inter-observer agreement (kappa-statistic) within each illness category. RESULTS: We found that the overall nurse-physician agreement on triage categorization had a kappa-value of 0.32 (99% confidence interval, 0.27-0.37). The level of inter-observer agreement was not consistent across all illness categories. Agreement was better when assigning critical patients, but it was poor when assigning non-emergency patients. CONCLUSION: The overall nurse-physician agreement with triage categorization was poor. The lack of agreement on triage decision making has important implications for EDs in which the priority of care is based on nursing triage categorization. Detailed chart recording and continued work is necessary to improve the agreement between nurse-physician triage categorization. Med Trop (Mars) 2002;62(3):263-7Related Articles, Links [Natural selection and medical triage: everyday realities] [Article in French] Carpentier JP, Petrognani R, Raynal M, Ponchel C, Saby R. Most emergency care facilities in tropical areas are inefficient, underequipped, and quickly overwhelmed by the ever-growing attendance. As a result, mortality is higher than in developed countries. To speak in terms of natural selection would be tantamount to a fatalistic admission of powerlessness to deal with the situation. In Africa, the gross imbalance between supply and demand makes it necessary to make hard choices in order to make the most effective use of available staff and equipment. The objective of medical triage is to allocate scarce facilities to those patients with the greatest chance of survival. However it is difficult to define precise rules for making such choices since they are strongly dependent on available resources, type of pathology, and level of medical skill. Prognostic indicators are ill-suited to emergency situation since they require not only clinical data but also and above all, in most cases, laboratory data which is not always available or justifiable. Experience is probably the best guarantee for reliable triage, which is philosophically difficult to accept but often unavoidable in everyday practice. Health Care Manag (Frederick) 2002 Sep;21(1):39-45Related Articles, Links The Emergency Room Medical Group: improving hospital efficiency. Oetjen D, Rotarius T. Health Services Administration Program, University of Central Florida, Orlando, USA. With national health care expenditures in the United States consuming 14 percent of the gross domestic product, the U.S. health care industry faces a turbulent environment. Adding to this situation, health care executives are having a difficult time developing strategies for dealing with patients who use the emergency room for primary care. Hospital executives may consider forming an Emergency Room Medical Group (ERMG). ERMGs are defined (as well as their alternative health care alliances), and each is illustrated in a model called the Physician Alliance Continuum. Ambul Pediatr 2002 Sep-Oct;2(5):396-400Related Articles, Links Consistency of triage decisions by call center nurses. Belman S, Murphy J, Steiner JF, Kempe A. Department of Pediatrics, University of Colorado Health Science Campus, Denver, CO, USA. [EMAIL PROTECTED] OBJECTIVES: To 1) assess consistency in triage disposition among pediatric telephone triage nurses using computer-based algorithms and 2) determine agreement between nurse dispositions and protocol dispositions. DESIGN/METHODS: Fifteen nurses from the After Hours Telephone Care Program in Denver were randomly selected to receive mock calls from standardized patients. Each nurse received the same 15 scenarios. Reliability in triage disposition was assessed using the kappa statistic. Audiotapes of cases were reviewed if an urgent referral was warranted by the protocol but not given 20% or more of the time. RESULTS: Mean agreement among nurses for individual cases was 83% (range, 64%-100%). Overall interrater reliability among nurses for triage disposition was 0.46 (95% confidence interval, 0.43-0.49). Mean agreement between nurses' dispositions and protocol dispositions was 81% (range, 33%-100%). Audio review revealed no differences in length of call or information elicited between cases receiving urgent and nonurgent dispositions. Reasons for incorrect dispositions were 1) information necessary to make the disposition directed by the protocol was given and ignored and 2) nurses did not elicit the necessary information prescribed by the protocol. CONCLUSIONS: Agreement regarding disposition decisions among call center nurses and between nurses and protocols was close to 80%. Disagreement with protocol dispositions occurred when nurses 1) did not follow protocols or 2) did not act on information provided by the parent. Our data suggest a need for additional attention to communication skills and to protocol adherence in training and ongoing quality improvement practices. _______________________________ Bonjour à toutes à tous, Ce message pour vous signaler qu'en Belgique, il existe une formation Spécifique pour le personnel infirmier. Cette formation s'étale sur une année de plein exercice et l'enseignement couvrent tant les matières relatives à l'urgence que celles relatives aux soins intensifs. La réussite de la formation mène à l'obtention du titre professionnel particulier "d'infirmier(e) gradué(e) en soins intensifs et d'urgence". Les hôpitaux sont obligés d'avoir un certain quota d'infirmier(e)s porteur(-euse)s de ce titre pour l'agrément des services d'urgence et de soins intensifs. Le titre est attribué pour une durée de six ans. Il est renouvellé pour Une période équivalente si le personnel infirmier fourni la preuve qu'il a suivi une formation permanente équivalante à deux journées par an ET qu'il exerce effectivement encore dans un service d'urgence ou de soins intensifs. Il est probable que dans un avenir plus ou moins proche, l'ensemble du Personnel infirmier de ces secteurs spécifiques devra être porteur du titre. A noter également que la législation belge impose aussi aux Services Mobiles d'URgence (SMUR) de compter un(e) infirmier(e) parmi l'équipage (outre le médecin bien entendu). Vous pouvez trouver des informations complémentaires au travers de la législation belge spécifique disponible sur le site de l'Association Francophone des Infirmier(e)s d'Urgence (AFIU) à l'adresse suivante : http://users.skynet.be/afiu Meilleures salutations de Belgique Christian Toumpsin Infirmier gradué en soins intensifs et d'urgence ______________________________
