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Calibrating urgency: triage decision-making in a pediatric emergency department

机译：校准紧急性：小儿急诊科的分诊决策

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摘要

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.
机译：分诊是评估急诊科患者的第一步，它发生在高度动态的环境中，该环境在时间，物理空间和患者需求（可能超过可用资源）的限制下运行。通过分类，使用诊断信息的子集将患者划分为有限数量的类别之一。为了简化此任务并使分类决定流程标准化，已实施了分类指南。但是，经验丰富的（专家）护士和经验不足的（新手）护士对这些协议的解释不同。这项研究调查了分类的过程。影响分类分类决策的因素，以及在流程中如何使用准则。通过对分诊护士的观察和半结构化访谈，在加拿大一家大型教学医院的儿科急诊科收集了数据。结果表明，在紧急情况下（1）分诊决策通常是非分析性的，并且基于直觉，尤其是在专业知识不断增强的情况下;（2）护士在分诊过程中使用的指南有所不同。这些结果表明，随着护士积累经验，明确的指南信息将被内化并隐式地用于紧急分诊实践中。讨论了这些结果对护理教育和培训的意义，以及对急诊护理指南的制定。

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