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Publikationer

METHODOLOGY

  1. Physician-led team triage based on lean principles may be superior for efficiency and quality?

    Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

    Authors: Lena BurströmEmail author, Martin Nordberg, Göran Örnung, Maaret Castrén, Tony Wiklund, Marie-Louise Engström and Mats Enlund
    Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:57
    © Burström et al.; licensee BioMed Central Ltd. 2012
    Keywords: triage models

    Background:

    The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second.

    Methods

    All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days.

    Results

    Data from 147,579 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p < 0.001). The rate of patients left before treatment was completed was 3.1% for physician-led team triage, 5.3% for nurse/emergency physician, and 9.6% for nurse/junior physician triage (p < 0.001). Further, the rates of unscheduled return within 24 hours were significantly lower for physician-led team triage, 1.0%, compared with 2.1%, and 2.5% for nurse/emergency physician, and nurse/junior physician, respectively (p < 0.001). The mortality rate within 7 days was 0.8% for physician-led team triage and 1.0% for the two other triage models (p < 0.001).

    Conclusions

    Physician-led team triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.

    Link: https://doi.org/10.1186/1757-7241-20-57

  2. Shorter waiting times at the emergency room with physicians in the triage team

    Shorter waiting times at the emergency room with physicians in the triage team. Comparison of standard and emergency medical care triage

    Source: läkartidningen nr XX 2010 volym 107,
    Authors: Fabian Ruben, med kand, Sahlgrenska universitetssjukhuset, Göteborg, Bengt Widgren, överläkare, docent, akut- och olycksfallsmottagningen, Sahlgrenska universitetssjukhuset, Göteborg; FoUU-chef Halland bengt.widgren@gu.se
    Keywords: Triage lead time

    Summary:

    Lead or waiting times at emergency reception is a matter that is increasingly focused. Historically, the principal has had difficulty finding an organization that, with its own resources, is able to reduce lead times to an immediate disposal of all patients, which should be both reasonable and possible.

    Method:

    At the emergency and accident reception, Sahlgrenska, an organizational model was studied, including standard transport and doctoral surgery, where the medical assessment is done directly in connection with triage and METTS constituted decision support.

    Results:

    As expected, lead time to doctors was significantly reduced by the doctor’s surgery, and the total treatment time was also reduced.

    Conclusion:

    The conclusions we draw are that it is possible to organize the doctors’ work so that they are part of the triage team, thus achieving early and increased skills while reducing lead times. An organizational problem may be that emergency care is not responsible for the entire emergency procedure, but the planning of doctors’ work is often governed by activities other than emergency services. This highlights that the overall responsibility for the emergency care chain should not be divided into different activities within the hospital

    Link: https://svemedplus.kib.ki.se/Default.aspx?Dok_ID=119146

  3. Emergency care safer and more efficient with common methods

    Emergency care safer and more efficient with common methods

    Authors: Bengt R Widgren, överläkare, docent, verksamhetschef, akut-och olycksfallsmottagningen bengt.widgren@gu.se
    Per Örninge, ambulansöverläkare, ambulanssjukvården; båda vid Sahlgrenska universitetssjukhuset, Göteborg Sven Grauman, leg läkare, akutkliniken,
    Östersunds sjukhus Kristian Thörn, biträdande överläkare, medicinskt ledningsansvarig, akutkliniken och ambulanssjukvården, Universitetssjukhuset, Örebro
    Source: Läkartidningen nr XX 2009 volym 106
    Keywords: vital parameters, symptoms, signs

    Purpose:

    At the University Hospital in Örebro, a project was started in 2005 using standard vital parameters prehospital. The purpose was to identify the severest ill at an early stage

    Result:

    Standardizing assessments and treatment based on vital parameters, symptoms, and signs prehospital and hospital allows the healthcare network to use the same emergency record throughout the emergency course. Moreover, using the same language and documentation reduces the risk that information will be lost in the surrender between prehospital and hospital emergency care. In addition to providing a safer triage prehospital, this method releases resources on emergency care, resources that can be used to reduce the dangerous time between arrival and triage for non-ambulance patients.

    Conclusion:

    The need to introduce more standardized processes, SOPs (standard operating procedures), in chains of care that includes several principals is large. SOPs can also contribute to resource optimization and quality improvements so that patients are properly judged and receive proper care at the right time.

    Link: http://www.lakartidningen.se/OldWebArticlePdf/1/13282/LKT0949s3348_3349.pdf

  4. Validation of Swedish Emergency Medical Index in trauma patients

    Validation of Swedish Emergency Medical Index in trauma patients

    Authors: Schagerlind L1, 2,*, Örtenwall P1, Widgren BR2, Taube M3, Asplén B1, Örninge P1, Khorram-Manesh A1,* 1. Prehospital and Disaster Medicine Centre, Gothenburg, Sweden, 2. Research and development unit (FFOU), Halmstad, Sweden 3. Sahlgrenska University Hospital, Gothenburg, Sweden
    Source: Journal of Emergency & Disaster Medicine 2, 1 (2013) | Article
    Keywords: triage, RETTS (Rapid Emergency Triage and Treatment System) medical index (MI), accuracy

    Introduction:

    All incoming medical calls to a Swedish dispatch center are triaged using a medical index (MI). In a recent study, we presented a discrepancy between priority set by the dispatchers and the ambulance crews using a clinical, knowledge based, triage. In this study, we aim at investigating the accuracy of this medical index, by comparing it to a validated prehospital/hospital triage; RETTS (Rapid Emergency Triage and Treatment System), in a group of trauma patients during a known period of time, using available medical records, including outcome.

    Material and Method:

    All ambulance transports in Gothenburg Sweden, registered during 2010 and all trauma patients triaged with both systems; MI by dispatchers and RETTS by ambulance crews were reviewed. The outcome of each patient could be retrieved by using the national trauma registry “KVITTRA.” In dubious cases, the conversation between the caller and emergency dispatcher could also be reviewed.

    Results:

    We found over-triage of 35% and under-triage of 15.5% among 3079 patients, triaged with both MI and RETTS. Of 27 under-triaged patients, 3 died within 30 days after trauma (all over 80 years of age). Analyses of conversation tapes revealed only one preventable death.

    Conclusion:

    We conclude that, when compared to a validated triage method, Swedish MI seems to have an acceptable level of accuracy. It might be possible to improve its accuracy, to some extent, by adding some specific questions into its algorithm. However, to prove this hypothesis; we would need a larger study with a more unselected study population.
    Link: https://www.researchgate.net/publication/252929911_Validation_of_Swedish_Emergency_Medical_Index_in_trauma_patients

PREDICTIVE VALUE

  1. More efficient trauma care with prehospital METTS-T triage.

    More efficient trauma care with prehospital METTS-T triage. A simple and medically safe method according to a retrospective study

    Authors:  BENGT R WIDGREN, docent, överläkare, verksamhetschef bengt.widgren@medic.gu.se GREGER NILSSON, leg nurse, traumakoordinator PER ÖRTENWALL, docent, överläkare, surgery clinic; as acue care and trauma department Sahlgrenska Universitetssjukhet/ Sahlgrenska och kirurgkliniken Sahlgrenska Universitetssjukhuset/Sahlgrenska, Göteborg
    Source: Läkartidningen nr 11 2009 volym 106.
    Keywords: validity and predictive value

    Purpose:

    Activation of a trauma alarm is done by the responsible emergency nurse having a telephone or ambulance or helicopter contact and structuring questions according to the METTS-T protocol. The trauma alert level is based on the algorithm of the METTS-T protocol, which contains the Trauma Journal, which contains criteria for vital parameters ABCD, patient anatomical damage and injury mechanisms.

    Methods:

    Activation of a trauma alarm is done by the responsible emergency nurse having a telephone or ambulance or helicopter contact and structuring questions according to the METTS-T protocol. The trauma alert level is based on the algorithm of the METTS-T protocol, which contains the Trauma Journal, which contains criteria for vital parameters ABCD, patient anatomical damage and injury mechanisms.

    Results:

    RESULTS Basic data. The highest level of trauma alert, red, accounted for 42 percent of all trauma alarms, meaning that the complete activation of the trauma team had decreased by 58 percent after the leveling was introduced. Of all trauma patients, 30 percent were women. At a red priority level, 28 percent were women and in orange priority level 31 percent, which shows that the distribution between the groups, relative to the total number of men and women, was relatively different in the target material. The age within or between the trauma alarm levels did not differ significantly between the sexes (Table I).

    Conclusion:

    With the right protocol, properly used in a stable organization, the trauma alert level is correct and medically safe. In our material, the proportion of overtrainment was low and the proportion of the underriage was almost non-existent, which is a prerequisite for the prehospital level division and selective activation of the trauma team.

    Link: https://svemedplus.kib.ki.se/Default.aspx?Dok_ID=109996

  2. Blood Lactate: A Useful Analysis in Emergency Care

    Blood Lactate: A Useful Analysis in Emergency Care

    Authors: Bengt R Widgren and Monique Ekhardt, 2011; vol 108: 475-477. Copyright 2011 by Author, Sweden.Translated by Radiometer Medical ApS.
    Source: “Serumlaktat – användbar analys inom akutsjukvården”, Läkartidningen and AB Typoform
    Keywords: priority, lactate

    Background:

    In emergency care triage, diagnosis and intervention time is usually important. In addition to a validated decision process, further analyses are often needed to make decisions concerning priorities, diagnostics, and treatment, preferably in close association with the initial medical assessment.

    Purpose:

    At the Emergency Medical Department, the relationship between priority and outcomes in patients with high blood lactate is being studied, along with lactate’s effect on reassessment.

    Results:

    The group with high blood lactate is given higher priority in accordance with RETTS, had longer in-hospital care and higher hospital mortality. Their vital signs on admission are also more affected. Blood lactate is a variable included in the RETTS protocol, and values >5 mmol/L result in reclassification to a higher priority.

    Conclusion:

    We conclude that blood lactate taken on admission provides additional useful information that can offer further support during the acute processing phase.

    Link: https://acutecaretesting.org/en/articles/blood-lactate-a-useful-analysis-in-emergency-care

RELIABILITY

  1. First evaluation of the paediatric version of the Swedish RETTS shows good reliability

    First evaluation of the pediatric version of the Swedish rapid emergency triage and treatment system shows good reliability

    Authors: Hanna Westergren, Martin Ferm, Per Häggström
    Source: 2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 30 December 2013
    Keywords: Emergency; Paediatric; Reliability; Retts-p; Triage

    Purpose:

    To investigate the reliability of Retts-p, Rapid emergency triage, and treatment system-pediatric, with regard to inter-rater and intra-rater agreement.

    Method:

    Twenty nurses responsible for triaging both children and adults at the Emergency Department, Östersund County Hospital, Sweden, were randomly selected to take part in the study. The nurses were asked to use the Retts-p triage system to retrospectively assess the written case reports on 40 pediatric cases, aged from 6 months to 17.5 years, who attended the Emergency Department in 2010 with surgical, orthopedic and medical symptoms. Using the information provided regarding appearance, symptoms, previous medical history and vital signs, the nurses selected the most appropriate Emergency Symptoms and Signs algorithm and placed the child in one of the five triage categories. Two test rounds were performed, 3 months apart, using the same cases, to study both the inter-rater and intra-rater agreement for the priority level and the triage algorithm chosen by the triage nurses.

    Results:

    Good to a very good agreement was shown for both inter-rater (quadratic κw 0.86, 95% CI 0.85–0.87) and intra-rater testing (quadratic κw 0.92, 95% CI 0.88–0.96).

    Conclusion:

    Retts-p provided good to very good reliability in this first evaluation study of the triage system.

    Link:http://onlinelibrary.wiley.com/doi/10.1111/apa.12491/full

  2. A reliability study of the RETTS system for children

    A reliability study of the rapid emergency triage and treatment system for children

    Authors: Brita Henning, Stian Lydersen, and Henrik Døllner
    Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:19
    Keywords: reliability children

    Background:

    To evaluate inter- and interrater reliability of a new Scandinavian triage system for children, the Rapid Emergency Triage and Treatment System-pediatric (RETTS-p).

    Methods:

    Two observational studies were conducted at the Pediatric Emergency Department (PED), St. Olav’s University Hospital, Trondheim, Norway. Using RETTS-p, nurses assign one of five triage priority levels to each patient on the basis of clinical signs and symptoms evaluations and vital parameter measurements.

    Study 1: Prior to the introduction of RETTS-p, in 2012, all nurses in the PED completed a theoretical and practical training. Four months later, 19 nurses triaged 20 fictive but realistic pediatric cases two times 9 months apart (Waves A and B). Study 2: Nurse pairs consisting of a regular nurse and a research nurse simultaneously and independently triaged 200 pediatric patients who were referred with various common medical and surgical complaints.

    Results:

    Study 1: Kendall’s W for Waves A and B were 0.822 and 0.844, respectively. Using a mixed linear model, we found no difference in triage priority levels between Waves A and B. Compared to a consensus level made by the research group, the nurses rated 85.1 % fictive cases correctly, and 99 % were rated correctly or within one adjacent priority score. Study 2: The interrater correlation coefficient in a linear mixed model was 0.762, confirming a high interrater reliability in real-life triaging.

    Discussion:

    We found a very high degree of agreement between nurses who used RETTS-p to prioritize children, both in a theoretical case scenarios study, but also in real-life triaging.

    Conclusions:

    RETTS-p may be a credible and robust triage system, but it has not been validated yet.

    Link: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-016-0207-6

VALIDITY

  1. The predictive validity of RETTS-HEV

    The predictive validity of RETTS-HEV as an acute triage tool in the emergency department of a Danish Regional Hospital

    Authors: Pérez, Noel1Nissen, Louise1Nielsen, Rasmus F.1Petersen, Poul1Biering, Karin2
    Source: European Journal of Emergency Medicine, Volume 23, Number 1, February 2016, pp. 33-37(5)
    Keywords: cohort study, mortality, predictive validity

    Introduction:

    The Rapid Emergency Triage and Treatment System – Hospital Unit West (RETTS-HEV) is a triage system used in the emergency department (ED) in Herning, Denmark, since 2010. It categorizes patients according to priority and defines a time limit on how long patients can wait before being seen by a doctor depending on the severity of their condition. The purpose of this study was to determine the predictive validity of RETTS-HEV by measuring the association between triage scores and outcomes such as the admission rate, the length of stay (LOS), and mortality.

    Materials and methods:

    We performed an observational cohort study by examining the medical records of all patients who attended the ED from 1 September 2012 to 30 November 2012, at the Regional Hospital West Jutland in Herning, Denmark (N=4680). We defined the following outcomes to make associations with the patients’ triage category: in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS and the admission rate, on the basis of complete information from the Danish National Patient Registry.

    Results:

    The distribution of age, comorbidity, admission, LOS, and mortality over triage categories differed as expected. After making adjustments for these differences, we found a consistent association between triage categories and in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS, and the admission rate. Conclusion  RETTS-HEV was found to be closely related to all examined outcomes, and therefore useful in the risk stratification of ED patients.

    Link: http://www.ingentaconnect.com/content/wk/ejeme/2016art00008

  2. The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population

    The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population

    Authors: Malin Ljunggren, Maaret Castrén, Martin Nordberg and Lisa Kurland
    Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016 24:2
    Keywords: vital signs mortality cohort study

    Background:

    Vital signs are widely used in emergency departments. Previous studies on the association between vital signs and mortality in emergency departments have been restricted to selected patient populations.

    Purpose:

    We aimed to study the association of vital signs and age with 1-day mortality in patients visiting the emergency department.

    Methods:

    This retrospective cohort included patients visiting the emergency department for adults at Södersjukhuset, Sweden from 4/1/2012 to 4/30/2013. Exclusion criteria were: age < 18 years, deceased upon arrival, chief complaint circulatory or respiratory arrest, key data missing and patients who were directed to a certain fast track for conditions demanding little resources. Vital sign data was collected through the Rapid Emergency Triage and Treatment System – Adult (RETTS-A). Descriptive analyses and logistic regression models were used. The main outcome measure was 1-day mortality.

    Results:

    The 1-day mortality rate was 0.3%. 96,512 patients met the study criteria. After adjustments of differences in the other vital signs, comorbidities, gender and age the following vital signs were independently associated with 1-day mortality: oxygen saturation, systolic blood pressure, temperature, level of consciousness, respiratory rate, pulse rate and age. The highest odds ratios was observed when comparing unresponsive to alert patients (OR 31.0, CI 16.9 to 56.8), patients ≥ 80 years to <50 years (OR 35.9, CI 10.7 to 120.2) and patients with respiratory rates <8/min to 8-25/min (OR 18.1, CI 2.1 to 155.5).

    Discussion:

    Most of the vital signs used in the ED are significantly associated with one-day mortality. The more the vital signs deviate from the normal range, the larger are the odds of mortality. We did not find a suitable way to adjust for the inherent influence the triage system and medical treatment has had on mortality.

    Conclusions:

    Most deviations of vital signs are associated with 1-day mortality. The same triage level is not associated with the same odds for death with respect to the individual vital sign. Patients that were unresponsive or had low respiratory rates or old age had the highest odds of 1-day mortality.

    Link: The association between vital signs and mortality

  3. Inter-rater agreement of the triage system RETTS-HEV

    Inter-rater agreement of the triage system RETTS-HEV

    Authors: Nissen, Louisea; Kirkegaard, Hansc; Perez, Noela; Hørlyk, Ulfa; Larsen, Louise P.
    Departments of Emergency Occupational Medicine, Regional Hospital of Herning, Herning Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark.
    Source: European Journal of Emergency Medicine: February 2014 – Volume 21 – Issue 1 – p 37–41
     Keywords: inter-rater agreement

    Objective:

    The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system – hospital unit west) in a Danish emergency department (ED).

    Background:

    The use of triage systems in Denmark has been implemented recently together with structural changes in the hospital organization. Testing and evaluation are therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semi-large, with 29 000 annual visits.

    Materials and Methods:

    Consecutive patients presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss.

    Results:

    A total of 155 patients were triaged over a 10-day period and complete data were available for 146 patients. We found the overall agreement to be good [Fleiss κ 0.60 (95% confidence interval 0.48; 0.72)]. The κ estimate was higher for the group of patients who required immediate attention [0.83 (95% confidence interval 0.18; 1.47)].

    Conclusion:

    The study found good inter-rater agreement between two independent observers not receiving any new triage training before the study.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/23797391

  4. METTS-T offers high medical security in primary trauma acute care

    METTS-T offers high medical security in primary trauma acute care

    Authors: Bengt Widgren, Greger Nilsson, Per Örtenwall Akut och Olycksfallsmottagningen SU/Sahlgrenska och Kirurgkliniken SU/Sahlgrenska Sahlgrenska Universitetssjukhuset Göteborg
    Source: Poster
    Keywords: validity, sensitivity, specificity

    Purpose:

    To validate prehospital and hospital triage of psychiatric patients with trauma regarding sensitivity and specificity of METTS-T.

    Method:

    520 consecutive trauma patients were included in the first half of 2007. All patients were triaged according to the same criteria both prehospital and on arrival at the emergency room. The criteria in METTS-T fall into three categories; a) impact on certain physiological parameters (respiration, circulation, and consciousness), b) certain specific anatomical damage and c) injury mechanism. These criteria together provide the priority level and also determine the alarm level, red or orange alarm. Sensitivity and specificity were evaluated. The predictive ability of the method for care time, mortality and the 30-days outcome was analyzed.

    Result:

    In this study, the METTS-T algorithm provides a low proportion of overtriage and undertriage, which is a prerequisite for a prehospital level division and selective activation of the trauma team in two different alarm levels.

     Conclusion:

    The study showed that METTS-T is a safe protocol for trauma care and with high sensitivity and specificity. Leveling based on METTS-T also reduces resource utilization when activating the trauma team without affecting medical quality and safety negatively. The study also shows that parts of the emergency care chain can be standardized, which results in reduced variability in treatment and increased medical safety, and that this can also be done in different organizations that work together with professionals.

    Link: http://predicare.se/content/uploads/Poster_METTS-T_predicare.pdf

  5. METTS-A; a protocol for safer emergency care.

    METTS-A; a protocol for safer emergency care. A report from the Accident and Emergency Department SU / Sahlgrenska University Hospital

    Authors: Bengt R Widgren Överläkare, Docent. Majid Jourak Leg Läk. Ann Martinius Leg sjuksköterska. Vid Akut och Olycksfallsmottagningen SU/Sahlgrenska Sahlgrenska Universitetssjukhuset, Göteborg.
    Source: Report from Sahlgrenska University Hospital
    Keywords:  triage, emergency room, mortality, vital signs

    Purpose:

    To validate the triage method in a new emergency response (METTS-A medical emergency triage and treatment system-adult) at an emergency room.

    Method:

    2,317 consecutive patients were included. Priority outcomes, the importance of vital parameters for priority level and emergency mortality were analyzed. Mortality during subsequent care was analyzed for patients inpatient, n = 17 921.

    Result:

    The proportion of need for end-care increased with increasing priority level. A correlation between acute mortality and mortality during subsequent care time, and the initial priority level were noted. In high priority patients, respiratory rate and degree of alertness were the strongest influencing the priority level.

    Conclusion:

    METTS-A has a high sensitivity to identify the most severe patients and a strong correlation between mortality and priority level were observed. At high priority, vital parameters play a major role in the priority level.

    Link: http://predicare.se/content/uploads/LT_070903_predicare.pdf

     

  6. METTS: a new protocol in primary triage and secondary priority decision in emergency medicine.

    Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine.

    Authors: Widgren BR1, Jourak M
    Source: J Emerg Med. 2011;40(6):623–8
    Keywords: triage; vital signs; mortality; hospital stay; emergency medicine

    Background:

    In many Emergency Department (ED) triage scoring systems, vital signs are not included as an assessment parameter.

    Objectives:

    To evaluate the validity of a new protocol for Emergency Medicine in a large cohort of patients referred to in-hospital care.

    Methods:

    From January 1 to June 30, 2006, 22,934 patients were admitted to the ED at Sahlgrenska University Hospital. Of those, 8695 were referred to in-hospital care and included in the study. A new five-level triage tool, combining vital signs, symptoms, and signs in the triage decision, was used. A small control of the inter-rater disagreement was also performed in 132 parallel, single-blinded observations.

    Results:

    Fifty percent of the patients were admitted by ambulance and the other 50% by walk-in. Hospital stay was significantly (p < 0.001) longer in those admitted by ambulance (9.3 ± 14 days) as compared with walk-in patients (6.2 ± 10 days). In-hospital mortality incidence was higher (8.1%) in patients admitted by ambulance, as compared with walk-in patients (2.4%). Hospital stay and in-hospital mortality increased with higher level of priority. In the highest priority groups, 32-53% of the patients were downgraded to a lower priority level after primary treatment.

    Conclusion:

    In the present study, the METTS protocol was shown to be a reliable triage method and a sensitive tool for the secondary re-evaluation of the patient in the ED.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/18930373

  7. New accurate triage method. METTS-A yields basis for priority level decisions.

    New accurate triage method. METTS-A yields basis for priority level decisions.

    Authors: Widgren BR, Jourak M, Martinius A.
    Source: Lakartidningen. 2008;105(4):201–4.
    Keywords: validity sensitivity

    Purpose:

    The purpose of the retrospective study presented here was to validate triage according to METTS-A and its sensitivity to finding those with high medical risk and predict mortality; with the study, we also wanted to identify criteria for the patients who are being treated for emergency and accident reception and those who are registered for end-of-life care

    Method:

    To calculate the mortality rate of emergency and accident reception, the basic material was used n = 12,317, ie all consecutive patients who applied at the Accident and Emergency department in the second quarter of 2005. In order to calculate the mortality outside of the reception, ie during the subsequent care period, all patients who were enrolled for acute care were used and accident reception throughout 2005, excluding the patients who were admitted for final care between January 1st and January 17th, before METTS-A was introduced (n = 17,921). The interindividual variability of METTS-A was studied through 132 parallel independent observations by the regular nurses in the triage area, an emergency nurse, an experienced doctor and a midwife conducted triage simultaneously on the same patients.

    Result:

    Our study shows that using METTS-A as a method of triage, one can achieve high sensitivity in finding patients at high medical risk both in emergency care and during subsequent care.

    Conclusion:

    Our experiences and conclusions from the Accident and Emergency Department at Sahlgrenska University Hospital / Sahlgrenska are also that METTS-A is a simple, efficient and safe protocol that is easy to implement in the organization, regardless of the method used for triage.

    Link: http://ww2.lakartidningen.se/store/articlepdf/8/8615/LKT0804s201_204.pdf