急診檢傷護理人員與醫師在檢傷分類級數判斷上的一致性探討

The Exploration of Agreement among Emergency Nurses and Physicians about Triage Decisions

10.6440/TZUCMJ.199909.0255

江錦玲(Jin-Ling Jiang)；蔡芸芳(Yun-Fang Tsai)

檢傷護理人員 ； 檢傷分類級數 ； 一致性 ； triage nurse ； triage category ； agreement

慈濟醫學雜誌

11卷3期（1999 / 09 / 01）

255 - 262

繁體中文

目的：旨在探討急診檢傷護理人員與急診專科醫師在檢傷分類級數判斷上的一致性，並進一步探討護理人員的屬性對檢傷級數判斷的影響。方法：研究對象為花蓮某區域教學醫院急診室目前執行檢傷工作的護理人員，以前瞻性的方式來收集護理人員與醫師共同判斷的檢傷級數一致性比率為85%，Kappa一致性係數為0.601，而檢傷護理人員屬性與檢傷級數一致性比率僅因急診工作年資的不同而有統計上顯著差異。結論：本研究結果可提供實際數據以了解護理人員執行檢傷分類的能力，並可提供醫院急診單位護理主管在安排檢傷護理人員時所需資格條件之考量。

Objective: The purpose of this study was to investigate agreement among triage nurses and emergency physicians regarding triage decisions, and relevant factors that affect triage decisions of nurses at the emergency department of a regional hospital in Hualien, Taiwan. Patients and Methods: A prospective approach was used to collect data on triage category judgements from nurses and physicians. A questionnaire was used to obtain triage nurses’ demographic data. All data were analyzed by using SPSS statistical software. Results: Totally 4105 patients were triaged. The triage nurses’ judgements of urgency categories were compared with those of emergency physicians. The results revealed that inter-observer agreement was 85%, kappa=0.061. Four percent of patients were overtriaged, and 11% were undertriaged, especially emergency and urgent patients, by triage nurses. Conclusions: These findings suggest that improvement in triage nurses’ assessment ability with acute and critical patients is needed in order to improve emergency care. In addition, the proportion of nurses-physician agreements among nurses with over 2 years of emergency experience was significantly higher than for those with under 2 years of experience. Finally, several recommendations are made regarding nursing practice, nursing education, and nursing administration, as well as directions for future studies.