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응급실 환자 중증도 분류(TRIAGE)도구 개발에 관한 연구

The Development of a Triage tool for the Adult Patients in a Tertiary Emergency Department

간호학논문집 - 서울대학교 1998년 12권 1호 p.53 ~ 74
최희강, 박성애,
소속 상세정보
최희강 ( Choi Hee-Kang ) - 서울대학교병원
박성애 ( Park Sung-Ae ) - 서울대학교 간호대학

Abstract


Hospital emergency departments provide the immediate care to patients whose needs are very different in the equity. So the most important characteristics of the work of an emergency department is its variability. Both the number of patients arriving and the nature of the complaints fluctuate greatly. Increases in emergency use, shortages of nurses and intensive care unit beds and backlogs of emergency admissions have contributed to emergency department overcrowding and prolonged waiting times.
Triage is the process by which patients are assessed upon their arrival at a health care facility to determine the appropriate health care resource.
Triage involves the sorting of injured and ill persons into the categories that prioritize them for medical care according to the nature and severity of their injury or illness. The triage process evolved as an effective method to separate those requiring the immediate attention from those who can wait. The purpose of this study was to develop a triage tool for the adult patients in a tertiary emergency department.
Expert panel developed the four triage categories ; urgent, emergent, semiemergent, nonemergent and the triage tool, a list of specific guidelines based on vital signs, signs, and symptoms, and calculated the content validity of the indicators.
A prospective study was carried out by two nurses and a doctor on 157 patients in the Seoul National University Hospital using the triage tool from February 22nd to 26th, 1997.
The data were analyzed by percentage distribution, Wilcoxon signed rank test, ANOVA and multiple regression.
THe results were as follows :
1) The seven main indicators and six coindicators of triage tool were developed. The main indicators included airway open status, respiration rate, systolic blood pressure, pulse rate, body temperature, Glasgow Coma Scale, severity of pain and the coindicatiors included noisy respiration and use of respiratory accessory muscle, irregular Pulse, cyanosis and diaphoretic skin, obvious significant hemorrhage, anisocoria and light reflex abnormality, trauma of head & chest & abdomen and open fracture.
2) The correspondence rate of nurses was 91.08% and there was no significant differences(p=1.0000), while the correspondence rate of a nurse and the doctor was 82.17% and there was significant differences(p=.0057).
3) Among the 157 patients, the distribution of triage categories were 12 urgent patients(7.64%), 28 emergent patients(17.83%), 104 semiemergent patients(66.24%), 13 nonemergent patients(8.28%). The distribution of results after treatment corresponded with nurse’s triage.
4) There were significant differences in the mean scores of the main indicator according to the categories of respiration rate and Glasgow Coma Scale(p<.05). The coindicator distributed into 58.33% of urgent patients and 42.86% of emergent patients.
5) The explanation power of this tool was 39.37%(F (12,144)=7.792, p=.0001, R2=.3937), and the significant variables were Glasgow Coma Scale(p=.0062, R2=.2079), obvious significant bleeding(p=.0001, R2=.0835), severity of pain(p=.0050, R2=.0408). In case of urgent and emergent patients, the explanation power of this tool was 53.54%(F (12,27)=2.593, p=.0194, R2=.5254), and the significant variable was Glasgow Coma Scale(p=.0250, R2=.3457).
These results suggest that the effective triage can be carried out by nurse with the tool which is developed in this study.

키워드

중증도 분류(TRIAGE);응급실 환자
triage;emergency department patient

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