Analysis Of The Current Situation Of Emergency Triage And Application Of The Rapid Emergency Triage And Treatment System

Objective:Analyzing the process of emergency triage to find the demand of emergency triage.To explore the application effect of rapid emergency triage and treatment system(RETTS)preliminarily.Methods:1.The emergency department patients(age≥14)first visited to Tianjin Medical University General Hospital from 2018.3.26 to 2018.4.9 were triaged by professional triage nurses according to the original national health development planning commission issued in 2012,“the design of normative flow of emergency department”(WS/T390-2012)of the disease classification standard(hereinafter referred to as the "conventional method "),dividing the patients into level 1(very critical)、 2(critical)、 3(urgent)、 4(non-urgent).Rcording the patient’s general information(gender,age,medical records)、level、registration time、first visit time、last payment time、medical department final diagnosis.The waiting time of patients was calculated from first visit time to the registration time,and the length of time was the last payment time to the registration time.Actual level was determined according to the diagnosis and treatment process of medical emergency patients.SPSS 20.0statistical software was used to analyze the characteristics of general data of patients,department distribution,visit time distribution,disease grading distribution,waiting time,the length of time and triage quality of medical patients by independent sample t test,ANOVA test,LSD test,kruskal-walils H test,mann-whitney U test and chi-square test.2.The emergency department patients(age≥14)first visit to Tianjin Medical University General Hospital from 2018.11.20 to2018.11.26 were triaged by trained researchers and senior triage nurses respectively according to RETTS and conventional method at the same time,and divided into red(very critical),orange(critical),yellow(urgent),green(sub-urgent)and blue(non-urgent)and level 1,2,3,4.Recording the patients’ general information(gender,age,medical records)and level 、 medical department and final diagnosis.The accuracy level of triage was determinated according to the actual diagnosis and treatment process.SPSS20.0statistical software was used to compare the accuracy,error rate(under-triage rate,over-triage rate)and validity(sensitivity,specificity)of the two triage methods for identifying critically ill patients by using paired chi-square test(McNemar-bouker test)of paired design data.Results:1.Analysis of the current situation of emergency triage6942 patients were included in the study,with an average age of 49.4±19.6 years(14~101 years).There were 3,014 males(43.42%)and 3,928 females(56.58%).1,2,3 and 4 patients were 40(0.58%),244(3.51%),1334(19.22%)and 5324(76.69%),respectively.The top three departments with the largest number of patients were internal medicine 3216(46.33%),neurology 987(14.22%)and general surgery 543(7.82%).The median waiting time of grade 1,2,3 and 4 patients was 17 min,11min,14 min and 12 min,respectively,with statistically significant differences(P<0.05).The departments with long waiting time were internal medicine(M=27min)and neurology(M=12min).The length of time < 4h,4~8h,8~24h,24~48h,48~72h and72 h of patients in resuscitation roomwere respectively 84(27.10%),44(14.19%),87(28.06%),47(15.16%),23(7.42%)and 25(8.06%).The triage accuracy of traditional method for internal medicine patients was 78.76%,the sensitivity and specificity of identifying acute and critical medical patients were 38.71% and 98.31%,respectively2.The application of RETTS1405 patients were included in the study,with an average age of 49.7±19.2 years,598 males(42.60%)and 807 females(57.40%).The total accuracy of RETTS and conventional triage were 77.16% and 82.71%,respectively.The over-triage rate was19.07% and 1.92%,respectively.The under-triage rate was 3.77% and 15.37%respectively.The triage accuracy,sensitivity,specificity,specificity,negative predictive value,negative likelihood ratio of critically ill patients were 65.49% and 25.66%,65.49% and 25.66%,88.39% and 99.07%,96.70% and 93.84%,0.39 and 0.75,respectively.Conclusion:A large number of emergency patients have been increased,among which non-critical critical patients and internal emergency patients are the most,whichgreatly occupies limited medical resources such as manpower,material resources and space in the emergency department,leading to prolonged waiting time and length of time of critical critical patients,affecting the timely treatment of critical critical patients.RETTS can improve the accuracy and sensitivity of identifying critically ill patients compared with conventional triage,which is conducive to improving triage and medical quality,and ensuring the safety of patients..