To estimate the inter- and intra-rater reliability of triage ratings on Emergency Centre patients by South African nurses and doctors using the South African Triage Scale (SATS).
A cross-sectional ...reliability study was performed. Five emergency physicians and ten enrolled nursing assistants independently assigned triage categories to 100 written vignettes unaware of the ratings given by others. Four different quantitative reliability measures were calculated and compared. Graphical displays portrayed rating distributions for vignettes with mean ratings at different acuity categories.
The estimated quadratically weighted kappa for the group of emergency physicians was 0.76 (95% CI: 0.67–0.84) and for the group of nurses 0.66 (95% CI: 0.58–0.74). These values were close to the estimated intra-class correlation coefficients. For intra-rater reliability, the average exact agreement was 84%. The graphical displays showed that the least variability was evident in the vignettes that had a mean rating of ‘emergency’, ‘very urgent’ or ‘routine’.
This study indicates good inter- and intra-rater reliability among nurses and doctors using the SATS. It suggests that the SATS is reliably applied, and supports the feasibility of further implementation of the SATS in similar settings.
Objective To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing ...proximal care facilities.
Methods A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost.
Results The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001).
Conclusions Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost‐effective, appropriate access to care for all patients.
Objectif: Caractériser la population se présentant au Centre des Accidents et des Urgences à l’Hôpital Universitaire Komfo Anokye, et identifier les facteurs de risque associés au contournement des services de soins proximaux.
Méthodes: Un questionnaire structuré a été administréà des patients se présentant au Centre des Accidents et des Urgences durant deux semaines. Le questionnaire portait sur l’utilisation des ressources de soins de santé et les caractéristiques de la maladie ou la blessure en cours. Les mesures enregistrées comprenaient la démographie, le statut socioéconomique, la plainte principale, le transport et la mobilité, les raisons de choisir l’Hôpital Universitaire Komfo Anokye, l’utilisation et les coûts des services de soins de santé.
Résultats: La proportion totale des contournements des soins proximaux était de 33,9%. En analyse multivariée, les facteurs positivement associés au contournement comprenaient l’âge de plus de 38 ans (OR: 2,18; P = 0,04) et des visites préalables au service (OR: 2,88; P = 0,01). Les patients contournant étaient: moins susceptibles d’être assurés (OR: 0,31, P = 0,01), à la recherche de soins pour des blessures (OR: 0,42; P = 0,03) et d’avoir recherché des soins précédemment pour le même problème (OR: 0,10; P < 0,001).
Conclusions: Les patients qui contournent les services près d’eux pour rechercher des soins dans un centre urbain des accidents et des urgences au Ghana, le font pour une combinaison de raisons, y compris la familiarisation avec le service, la plainte principale et le statut d’assurance. Comprendre le comportement de contournement est important pour guider les décisions de la politique d’utilisation des soins de santé et la rationalisation du coût‐efficacité, pour l’accès approprié aux soins pour tous les patients.
Objetivo: Caracterizar la población que se presenta en el Centro para Accidentes y Emergencias del Hospital Universitario de Komfo Anokye, e identificar los factores de riesgo asociados con el pasar por alto los cuidados ofrecidos en centros cercanos.
Métodos: Se administró verbalmente, a lo largo de dos semanas, un cuestionario estructurado a los pacientes que se presentaron en el Centro para Accidentes y Emergencias. El cuestionario estaba enfocado al uso de recursos sanitarios y a las características de la enfermedad o lesión actual. Las medidas registradas incluían datos demográficos, estatus socioeconómico, principal motivo de consulta, transporte y movilidad, las razones para escoger el Hospital Universitario Komfo Anokye, y el uso de los servicios sanitarios y su coste.
Resultado: La tasa total de haber evitado los centros cercanos fue del 33.9%. En un análisis multivariado, los factores asociados de forma positiva con el haber pasado de utilizar un centro cercano incluían tener una edad mayor de 38 años (OR: 2.18, P 0.04) y haber realizado visitas anteriores al centro sanitario (OR 2.88, P 0.01). Los pacientes que evitaban un centro cercano tenían una mayor probabilidad de no estar asegurados (OR 0.31, P 0.01), de buscar ayuda por una lesión (OR 0.42, P 0.03), y de previamente haber buscado ayuda sanitaria para el problema (OR 0.10, P < 0.001).
Conclusiones: Los pacientes que pasaban de utilizar centros cercanos y buscan ayuda en un centro urbano para accidentes y emergencias en Ghana lo hacen por una combinación de razones que incluyen el estar familiarizados con el centro, la causa por la que consultan, y el estar o no asegurados. Entender el comportamiento de pasar de un centro cercano es importante para tener en cuenta a la hora de realizar políticas sanitarias y ofrecer acceso a cuidados apropiados y coste‐efectivos para todos los pacientes.
Development of Australia's first psychiatric emergency centre Frank, Rowena; Fawcett, Lisa; Emmerson, Brett
Australasian psychiatry : bulletin of the Royal Australian and New Zealand College of Psychiatrists,
September 2005, Letnik:
13, Številka:
3
Journal Article
Recenzirano
Objectives: To describe the development of the first Australian psychiatric emergency centre co‐located with the Emergency Department at the Royal Brisbane and Women's Hospital. This paper covers the ...current operational model, significant partnerships and benefits of this service, which assesses and treats over 7200 presentations per year.
Conclusions: The co‐location of the Psychiatric Emergency Centre and Emergency Department has created a unique model of service delivery and effective working relationships between the two services. The model improves clinical care providing multiple benefits for patients and the Emergency Department by means of direct access to specialized mental health staff, early mental health responsibility for patients and reduced access block.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
44.
Warning scores in triage – Is there any point? Gottschalk, Sean B.; Warner, Chris; Burch, Vanessa C. ...
African Journal of Emergency Medicine,
09/2012, Letnik:
2, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Introduction: The South African Triage Scale (SATS), a novel triage system for Emergency Centres, was initially proposed in 2006. The system incorporates an adapted version of the Modified Early ...Warning Score (MEWS). Methods: A prospective study was conducted to evaluate the use of the MEWS as a triage tool in EC settings in the Western Cape, South Africa. A total of 1867 cases were prospectively assessed. The MEWS was correlated with Emergency Centre outcome Results: The data show clear potential for use of the MEWS as a triage instrument for medical patients. Its use for trauma cases is more limited. Conclusion: The MEWS in its un-adapted form is unsuitable as a unified triage scoring system for both medical and trauma cases in Emergency Centres.
Despite the frequency and severity of burns in Low Income Countries, including many in Africa, there is a paucity of research and funding for these populations to aid in prevention, treatment and ...recovery of burn patients. The objectives of this paper are four-fold. First, by addressing the pathophysiology of burns the reader may strengthen understanding of the clinical progression of burns. Second, through describing proper assessment of burn patients one will learn how to decide if patients can be discharged, admitted or transferred to burn centre. Third, the inclusion of treatments solidifies the steps necessary to manage a patient in a hospital setting. Lastly, the overall goal of the paper, is to raise awareness that more research, publication and funding is required to create a better understanding of burns in Africa and why they continue to be devastating social and economic burdens.
Malgré la fréquence et la gravité des brûlures dans les pays à faible revenu, dont bon nombre en Afrique, il existe très peu d’études et de fonds destinés à ces populations pour aider à la prévention, au traitement et au rétablissement des patients victimes de brûlures. Les objectifs de cet article sont au nombre de quatre. Premièrement, en abordant la physiopathologie des brûlures, le lecteur aura la possibilité de renforcer sa compréhension de la progression clinique des brûlures. Deuxièmement, à travers une évaluation pertinente des patients brûlés, on apprendra comment décider si un patient peut quitter l’hôpital, être admis ou transferré dans un centre de brûlés. Troisièmement, le fait d’inclure des traitement renforce les étapes nécessaires pour prendre en charge un patient en milieu hospitalier. Finalement, l’objectif global de cet article est de faire prendre conscience que plus de recherche, de publications et de fonds sont nécessaires pour favoriser une meilleure compréhension des brûlures en Afique et pourquoi elles continuent d’être des fardeaux économique et social catastrophiques.
Background: The inappropriate use of emergency centres (ECs) is an expanding problem globally. The high attendance of non-urgent return presentations to ECs is recognised as part of the problem, ...placing an unnecessary demand on limited staff and resources. Of unscheduled returns 34% of cases had no change to diagnosis or treatment with the conclusion that 80% of re-attendance could be attributed to deficiencies in the initial consultation. This study aimed to evaluate the reasons why patients sought an early second consultation for the same complaint at a hospital EC in South Africa, by exploring the patient’s experience and shortcomings in the first consultation. Method: A qualitative study was conducted using in-depth, semi-structured interviews with 20 purposively selected participants who presented to a rural regional provincial hospital’s EC within 7 days of a prior consultation for the same complaint. Verbatim transcripts were analysed using the framework method. Results: The main reasons for a second consultation were symptom related factors and the need for diagnostic certainty. The major themes around patient experience of the initial consultation were shortcomings in effective evaluation and management of pain, diagnostic uncertainty including poor examination, poor explanation, uncertain access and follow-up and societal encouragement to utilise a hospital EC. Conclusion: Further interventions should explore pain as a presenting symptom of the illness experience, and promote competence in addressing physical and psychological causative factors within a patient-centred approach for all health staff, especially in primary care services.
Objective: To estimate the inter-rater reliability of triage ratings within individual cadres of health care workers (HCWs) and between different cadres of HCWs using the South African Triage Scale ...(SATS). Methods: Five final year medical students (FMSs), two enrolled nurses (ENs) and two Enrolled Nursing Assistants (ENAs), who had all been trained in the use of the SATS, were selected to prospectively triage Emergency Centre (EC) patients in real time. Twenty five patients were triaged twice on the first day by individual participants, and another 25 were triaged twice by a collaborative team on the second day. Quadratically weighted kappa (QWK) point estimates were calculated with 95% confidence intervals to assess agreement. Results: For 25 patients analysed on day one, the QWK values were very high within professions triaging individually: among the FMSs (QWK = 0.94; 95% CI: 0.82–1.0), among the ENs (QWK = 0.92; 95% CI: 0.74–1.0) and moderate between the FMSs and ENs (QWK = 0.57; 95% CI: 0.33–0.81). For 25 patients analysed on day two a team of ENA and FMS, triaging collaboratively, demonstrated moderate agreement (QWK = 0.65; 95% CI: 0.46–0.85). Conclusion: The inter-rater reliability of SATS ratings is excellent within individual HCWs, but significantly lower between different HCWs. This confirms previous reliability studies of the SATS using vignettes and if validated by larger studies would support the feasibility of further implementation of the SATS in primary health care settings across the Western Cape.
Objectives: Information and communication technologies (ICT) are introduced into organisations with the goals of managing resources, increasing efficiency and work productivity and reducing workload. ...The aim of this study was to identify hospital institutional capacity indicators to provide recommendations to an existing emergency management database system operating in Cape Town, the Western Cape Province of South Africa. Using these indicators, this study seeks to augment and update the existing emergency database system. Methods: A modified Expert Delphi study consisting of two rounds was conducted by email. A panel of 16 experts drawn from the fields of emergency medicine, critical care, trauma surgery and disaster medicine were consulted. Participants were initially asked to propose hospital institutional capacity indicators that warranted inclusion in the emergency management database system currently operating in Cape Town, South Africa. In the second round these proposals were collated and scored using a 7 point Likert scale. Results: Round 1 comprised 237 statements. Consensus was defined a priori to be >80%. A total of 59 of 237 statements had reached consensus upon completion of the Delphi study. This represented 24.5% of the total number of statements. Of these 19 reached consensus at >90% and 40 reached consensus at >80%. Subheadings for proposed indicators included staffing speciality categories, hospital equipment and services and special hazard/circumstance services Examples of accepted indicators include theatre availability, ICU surge and ventilator capacity and the availability of Chemical Biological Radiological Nuclear (CBRN) Decontamination services. Conclusion: The use of a modified Expert Delphi study achieved consensus in aspects of hospital institutional capacity that can be translated into practical recommendations for implementation by the local emergency management database system. Additionally, areas of non-consensus have been identified where further work is required. This purpose of this study is to contribute to and aid in the development of this new system.
The Incident and Emergency Centre (IEC) of the International Atomic Emergency Agency (IAEA) is the global focal point for preparedness and response to nuclear and radiological incidents and ...emergencies irrespective of their cause. In the area of preparedness the Centre continuously works to develop standards and guidance for strengthening Member States’ preparedness; practical tools and training programs to assist Member States in promptly applying the standards and guidance; and organizes a variety of training events and exercises. This paper provides an overview of the information presented in the IAEA Safety Standards and Guidance in the area of emergency preparedness and response.
PDF
