Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Triage Accuracy of Pediatric Patients using the Korean Triage and Acuity Scale in Emergency Departments

한국형응급환자분류도구를 적용한 응급실에서 소아 환자의 중증도 분류 정확성

  • Moon, Sun-Hee (Department of Nursing, College of Health and Welfare and Education, Gwangju University) ;
  • Shim, Jae Lan (Department of Nursing, College of Medicine, Dongguk University)
  • 문선희 (광주대학교 보건복지교육대학 간호학과) ;
  • 심재란 (동국대학교 의과대학 간호학과)
  • Received : 2018.08.29
  • Accepted : 2018.11.02
  • Published : 2018.11.30
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Abstract

This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

본 연구는 한국형응급환자분류도구(Korean Triage and Acuity Scale: KTAS)를 사용한 소아 중증도 분류의 정확성을 파악하기 위한 후향적 조사연구이다. 연구자료는 2016년 10월부터 2017년 9월까지 1개 권역응급의료센터, 1개 지역응급의료센터에 방문한 소아환자의 자료 중 무작위로 추출한 250건의 간호초진기록지와 진료결과였다. 수집된 자료를 검정된 전문가가 분석하여 true-triage를 정하였다. 중증도 분류 정확도는 응급실간호사의 중증도 분류 결과와 전문가의 true-triage결과와의 일치도로 평가하였다. 전문가 의견에 따라 중증도 분류 오류의 원인이 분석되었고, KTAS 등급과 퇴원, 체류시간, 진료비와의 연관성이 비교되었다. 연구결과 전문가와 응급실 간호사의 중증도 분류 등급은 높은 일치도를 보였다(weighted kappa=.77). 중증도 분류 불일치의 원인 중 활력징후 결과를 KTAS 알고리즘 기준에 잘 못 적용한 경우가 가장 많았다(n=13). KTAS 1,2 등급과 같이 중증도가 높을수록 퇴원이 적었다(${\chi}=43.25$, p<.001). 연령을 보정했을 때 KTAS 등급에 따라 체류시간(F=12.39, p<.001)과 진료비(F=11.78, p<.001)는 차이가 있었다. 본 연구결과 KTAS는 국내 응급실에서 높은 정확도를 보였으므로, 새로 개발된 중증도 분류 도구가 국내 응급실에 잘 적용되고 있다고 할 수 있다.

Keywords

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Fig. 1. Causes of mistriage

Table 1. Demographic data of participants

SHGSCZ_2018_v19n11_626_t0001.png 이미지

Table 2. Reliability scores between emergency nurses and experts

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Table 3. Clinical outcomes among KTAS scores

SHGSCZ_2018_v19n11_626_t0003.png 이미지

References

  1. S Mohiuddin, J Busby, J Savovic, A Richards, K Northstone, W Hollingworth, JL Donovan, C Vasilakis, "Patient flow within UK emergency departments: a systematic review of the use of computer simulation modelling methods", BMJ Open, Vol.7, No.5 pp. e015007, 2017. DOI: https://doi.org/10.1136/bmjopen-2016-015007
  2. M Christ., F Grossmann., D Winter, R Bingisser, E Platz, "Modern triage in the emergency department", Deutsches Arzteblatt International, Vol.107, No.50 pp. 892-8, 2010. DOI: https://doi.org/10.3238/arztebl.2010.0892
  3. EF Lahdet, BO Suserud, A Jonsson, L Lundberg, "Analysis of triage worldwide", Emergency Nurse, Vol.17, No.4 pp. 16-19, 2009. https://doi.org/10.7748/en2009.07.17.4.16.c7122
  4. SH Moon, YH Park, "Concept Analysis of Triage Competency in Emergency Nursing", Journal of Korean Critical Care Nursing, Vol.10, No.3 pp. 41-52, 2017.
  5. A Mirhaghi, A Heydari, R Mazlom, M Ebrahimi, "The reliability of the Canadian Triage and Acuity Scale: meta-analysis", North American journal of medical sciences, Vol.7, No.7 pp. 299-305, 2015. DOI: https://doi.org/10.4103/1947-2714.161243
  6. JB Park, HJ Choi, BS Kang, CS Kim, HG Kang, TH Lim, "A nationwide survey of Korean emergency department triage systems and scales: A first step towards reform of the emergency medical service system", Journal of the Korean Society of Emergency Medicine, Vol.25, No.5 pp. 499-508, 2014.
  7. Korean Society of Emergency Medicine. Validity and Reliability Report of the Korean Triage and Acuity Scale [Internet]. Seoul: Ministry of Health & Welfare, 2014, Available from: http://prism.go.kr/homepage/researchCommon/retrieveResearchDetailPopup.do?research_id=1351000-201400241 (accessed Apr., 1, 2018)
  8. JS Kim, "Main contents of improvement of emergency medical system", Health Insurance Review & Assessment Service Poilcy Brief, Vol.9, No.4 pp. 11-16, 2015.
  9. N Farrohknia, M Castren, M Ehrenberg, L Lind, S Oredsson, H Jonsson, K Asplund, KE Goransson, "Emergency department triage scales and their components: a systematic review of the scientific evidence", Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol.19, No.1 pp. 42, 2011. DOI: https://doi.org/10.1186/1757-7241-19-42
  10. RW Derlet, RM McNamara, AA Kazzi, JR Richards, "Emergency department crowding and loss of medical licensure: a new risk of patient care in hallways", Western Journal of Emergency Medicine, Vol.15, No.2 pp. 137, 2014. DOI: https://doi.org/10.5811/westjem.2013.11.18645
  11. Korean Triage and Acuity Scale (KTAS) Committee. Korean triage and acuity scale manual Version 1.0 [Internet]. Seoul: KTAS National Working Group, 2014, Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=1&research_id=1351000-201400241&leftMenuLevel=160&cond_research_name=%EC%A4%91%EC%A6%9D%EB%8F%84+%EB%B6%84%EB%A5%98&cond_research_start_date=&cond_research_end_date=&pageUnit=10&cond_order=3 (accessed Jun, 1, 2018)
  12. T Horeczko, B Enriquez, B, NE McGrath, M Gausche-Hill, RJ Lewis, "The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children", Journal of Emergency Nursing, Vol.39, No.2 pp. 182-189, 2013. DOI: https://doi.org/10.1016/j.jen.2011.12.020
  13. J Gravel, S Manzano, M Arsenault, "Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital", Canadian Journal of Emergency Medicine, Vol.11, No.1 pp. 23-28, 2009. DOI: https://doi.org/10.1017/s1481803500010885
  14. W Ma, A Gafni, RD Goldman, "Correlation of the Canadian pediatric emergency triage and acuity scale to ED resource utilization", The American journal of emergency medicine, Vol.26, No.8 pp.893-897, 2008. DOI: https://doi.org/10.1016/j.ajem.2008.02.024
  15. S Gouin, J Gravel, DK Amre, S Bergeron, "Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED", The American journal of emergency medicine, Vol.23, No.3 pp. 243-247, 2005. DOI: https://doi.org/10.1016/j.ajem.2004.02.046
  16. JW Shin, SH Lee, DS Lee, HB Kim, YM Jo, BG Bae, IJ Wang, MR Park, "Validity of the Newly Developed Five Level Pediatric Triage System Implemented in a Children's Hospital Emergency Department. The Korean Society of Emergency Medicine, Vol.28, No.6 pp. 557-563, 2017.
  17. JY Kim, DY Hong, SY Kim, JW Kim, SO Park, KR Lee, KJ Baek, "Reliability of Korean Triage and Acuity Scale-based Triage System as a Severity Index in Emergency Patients", The Korean Society of Emergency Medicine, Vol.28, No.6 pp. 552-56, 2017.
  18. KS Jang, A study on establishment of clinical career development model of nurses [dissertation], Seoul: Yonsei University, pp. 1-201, 2000.
  19. DV Cicchetti, "Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology", Psychological Assessment, Vol.6, No.4 pp. 284-90, 1994. DOI: https://doi.org/10.1037/1040-3590.6.4.284
  20. Emergency Nurses Association. Triage qualifications [Internet]. Des Plaines (IL): Emergency Nurses Association; c2011, Available from: https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/triagequalificationscompetency.pdf?sfvrsn=a0bbc268_8, (accessed Jun, 10, 2018)
  21. ES Lang, BH Rowe. Evidence-Based Emergency Medicine. p.58-65, Chichester: BMJ Books, 2011.
  22. M Hongxiang, Y Zhicai, "Law Problems One Should Pay Attention to in Writing Nursing Document After the Regulations for Handling Medical Treatment Accidents", Put Into Effect, Vol.3, 2003.