Implementation and refinement of the Emergency Severity Index
Implementation and refinement of the Emergency Severity Index
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DOI：
10.1111/j.1553-2712.2001.tb01283.x
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发表时间：
2001-02-01
影响因子：
4.4
通讯作者：
Yazhari, R
中科院分区：
文献类型：
--
作者：
Wuerz, RC;Travers, D;Yazhari, R
目的：实施一个新的五级急诊科（艾德）分诊算法，紧急情况严重程度指数（ESI），到护理实践中，并验证该工具与基于人口的队列使用住院和艾德住院时间作为结果的措施。研究方法：本研究将五级ESI算法应用于两所大学医院急诊科的分诊护士，并以强化与变革管理策略实施。评价者间的可靠性进行了评估后测试和一系列独立的配对病人分诊分配，并进行了工作人员调查。对实施后一个月内登记的所有成年患者进行了队列验证研究。结果：研究了8251例艾德患者。后测（n = 62名护士）分诊分配再现性的加权Kappa值为0.80，患者分诊（n = 219）为0.73。总体住院率为28%，与分诊水平密切相关，从分诊类别1的58/63（92%）患者降至分诊类别5的12/739（2%）。中位住院时间在任一分诊极端（高和低敏度）比中间类别短2小时。结果遵循先验预测。护士认为新程序更容易使用，比以前的三级分诊更有用。他们提供了反馈，导致对算法和教育材料进行了重大修改。结论：这两家医院的分诊护士成功地实施了ESI算法，并为进一步完善仪器提供了有用的反馈。急诊严重程度指数分类法可重复地将患者分为五组，具有不同的临床结局。
Objectives: To implement a new five-level emergency department (ED) triage algorithm, the Emergency Severity Index (ESI), into nursing practice, and validate the instrument with a population-based cohort using hospitalization and ED length of stay as outcome measures. Methods: The five-level ESI algorithm was introduced to triage nurses at two university hospital EDs, and implemented into practice with reinforcement and change management strategies. Interrater reliability was assessed by a posttest and by a series of independent paired patient triage assignments, and a staff survey was performed. A cohort validation study of all adult patients registered during a one-month period immediately following implementation was performed. Results: Eight thousand two hundred fifty-one ED patients were studied. Weighted kappa for reproducibility of triage assignments was 0.80 for the posttest (n = 62 nurses), and 0.73 for patient triages (n = 219). Hospitalization was 28% overall and was strongly associated with triage level, decreasing from 58/63 (92%) of patients in triage category 1, to 12/739 (2%) in triage category 5. Median lengths of stay were two hours shorter at either triage extreme (high and low acuity) than in intermediate categories. Outcomes followed a-priori predictions. Staff nurses rated the new program easier to use, and more useful as a triage instrument than previous three-level triage. They provided feedback, which resulted in significant revisions to the algorithm and educational materials. Conclusions: Triage nurses at these two hospitals successfully implemented the ESI algorithm and provided useful feedback for further refinement of the instrument. Emergency Severity Index triage reproducibly stratifies patients into five groups with distinct clinical outcomes.