Evaluation of Emergency Triage Using a Computerized Simulator
Summary
A four-level triage scale (the Geneva Emergency Triage Scale, GETS) has been used since 1997 in our emergency department (ED). A recent evaluation of this scale showed that our instrument had an excellent intra-rater reliability but insufficient inter-rater reliability. We also observed a wide variability in the way triage nurses perform (J Clin Epidemiology, 2006 in press). These variations in the triage process are mainly explained by a poor standardization of vital signs measurement. Therefore, we have recently modified our triage instrument and introduced explicit criteria for vital signs evaluation during the triage process.
The objectives of this study are:
- To evaluate the inter- and intra-rater reliability of our modified triage scale using a computer simulator
- To measure the impact of visual clues on the triage decisions when using the triage simulator
- To evaluate the performance of triage nurses and chief physicians in their triage decisions.
We expect to observe:
- an improvement of the inter-rater reliability of our instrument compared to the previous version
- a better standardization and more systematic use of vital signs measurement
- a higher reliability when visual clues are given to the evaluator
- lower rates of under- and over-estimation of emergency levels.
Description
A four-level triage scale (the Geneva Emergency Triage Scale, GETS) has been used since 1997 in our emergency department (ED). A recent evaluation of this scale showed that our instrument had an excellent intra-rater reliability but insufficient inter-rater reliability. We also observed a wide variability in the way triage nurses perform (J Clin Epidemiology, 2006 in press). These variations in the triage process are mainly explained by a poor standardization of vital signs measurement. Therefore, we have recently modified our triage instrument and introduced explicit criteria for vital signs evaluation during the triage process.
The objectives of this study are:
- To evaluate the inter- and intra-rater reliability of our modified triage scale using a computer simulator
- To measure the impact of visual clues on the triage decisions when using the triage simulator
- To evaluate the performance of triage nurses and chief physicians in their triage decisions.
We expect to observe:
- an improvement of the inter-rater reliability of our instrument compared to the previous version
- a better standardization and more systematic use of vital signs measurement
- a higher reliability when visual clues are given to the evaluator
- lower rates of under- and over-estimation of emergency levels.
Study Design
Allocation: Randomized, Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label
Conditions
Emergencies
Intervention
Visual clues
Location
Geneva University Hospitals
Geneva
Switzerland
1211
Status
Completed
Source
University Hospital, Geneva
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00321243
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Attentional Blink
Temporary visual deficit or impaired visual processing occurring in a rapid serial visual presentation task. After a person identifies the first of two visual targets, the ability to detect the second target is impaired for the next few hundred milliseconds. This phenomenon is called attentional blink.
Visual Acuity
Clarity or sharpness of OCULAR VISION or the ability of the eye to see fine details. Visual acuity depends on the functions of RETINA, neuronal transmission, and the interpretative ability of the brain. Normal visual acuity is expressed as 20/20 indicating that one can see at 20 feet what should normally be seen at that distance. Visual acuity can also be influenced by brightness, color, and contrast.
Vision Disorders
Visual impairments limiting one or more of the basic functions of the eye: visual acuity, dark adaptation, color vision, or peripheral vision. These may result from EYE DISEASES; OPTIC NERVE DISEASES; VISUAL PATHWAY diseases; OCCIPITAL LOBE diseases; OCULAR MOTILITY DISORDERS; and other conditions. Visual disability refers to inability of the individual to perform specific visual tasks, such as reading, writing, orientation, or traveling unaided. (From Newell, Ophthalmology: Principles and Concepts, 7th ed, p132)
Hemianopsia
Partial or complete loss of vision in one half of the visual field(s) of one or both eyes. Subtypes include altitudinal hemianopsia, characterized by a visual defect above or below the horizontal meridian of the visual field. Homonymous hemianopsia refers to a visual defect that affects both eyes equally, and occurs either to the left or right of the midline of the visual field. Binasal hemianopsia consists of loss of vision in the nasal hemifields of both eyes. Bitemporal hemianopsia is the bilateral loss of vision in the temporal fields. Quadrantanopsia refers to loss of vision in one quarter of the visual field in one or both eyes.
Evoked Potentials, Visual
The electric response evoked in the cerebral cortex by visual stimulation or stimulation of the visual pathways.
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