急診檢傷護理人員間使用E化五級檢傷分類系統級數判斷一致性及影響因素之探討

Exploring the Agreement and Affecting Factors of Using the Five-level Electronic Triage System among ED Triage Nurses

10.3966/102673012017032801001

張文(Wen Chang)；韓晶彥(Chin-Yen Han)；陳麗琴(Li-Chin Chen)；陳雅欣(Yea-Shin Chen)；羅美怡(Mei-Yi Luo)；劉雪娥(Hsueh-Erh Liu)

急診 ； 五級檢傷分類 ； 電腦化系統 ； 檢傷護理師 ； 一致性 ； emergency department ； the five-level triage ； electronic triage system ； triage nurses ； agreement

長庚護理

28卷1期（2017 / 03 / 01）

1 - 11

繁體中文

背景／目的：自2010年1月1日始全國各急診室統一使用新建構的五級檢傷分類電腦化系統進行病人檢傷分類。本研究目的在探討急診檢傷護理師執行E化五級檢傷分類系統的分級一致性及其影響因素。研究方法：採前瞻性、橫斷式研究法，以收集1位標竿護理師與14位急診檢傷護理師個別使用E化五級檢傷分類系統，同步進行病人檢傷分類的結果。自2012年8月至2013年7月，共收集239位有效樣本。研究結果：結果發現檢傷護理師與標竿護理師間的一致性“幾乎完全吻合”(weighted kappa= .886)，整體一致性為93.72%。檢傷低估有5.43%，檢傷高估為0.84%。以護理職級來看，一致性比率最高為N4（95.10%）。結論：研究結果顯示急診檢傷護理師使用E化五級檢傷分類系統執行檢傷分類的結果是可信的。工作年資與護理專業進階能力可作為檢傷一致性因素之考量，期望本研究結果可供各醫療院所訓練檢傷護理師課程之參考。

Background/Purpose: The five-level electronic triage system(Taiwan Triage and Acuity Scale, TTAS) was implemented over the emergency departments (ED) in Taiwan on January 1, 2010. The purpose of this study was to explore the agreement and affecting factors of five-level triage system among the ED triage nurses. Methods: This study was a prospective design. Data were collected by using one trained research nurse with fourteen ED triage nurses implementing the TTAS simultaneously to determine the triage level in ED patients. From August 2012 to July 2013, a total of 239 effective examples of ED patients were evaluated. Results: The results found that the inter-observer agreement was 93.72% with a weighted kappa of .886 of triage level among the ED triage nurses and the benchmark nurse. The under-triage was 5.43% and over-triage was 0.84%. The highest agreement ratio (95.10%) is the N4 of nursing clinical ladder. Conclusions: The results from this study indicated that the TTAS used by ED triage nurses was reliable. Years of clinical working experience and nursing clinical ladder were the affecting factors of the ED triage nurses' agreement. The results of this study could serve as a reference for designing training courses for triage nurses.

1. Alquraini, M.,Awad, E.,Hijazi, R.(2015).Reliability of Canadian emergency department triage and acuity scale (CTAS) in Saudi Arabia.International Journal of Emergency Medicine,8(29),2-4.
2. Becker, J.,Lopes, M.,Pinto, M.,Campanharo, C.,Barbosa, D.,Batista, R.(2015).Triage at the emergency department : Association between triage levels and patient outcome.Revista da Escola de Enfermagem da USP,49(5),779-785.
3. Chang, W.,Liu, H. E.,Goopy, S.,Chen L. C.,Chen, H. J.,Han, C. Y..Using the five-level Taiwan Triage and Acuity Scale computerized system: factors in decision making by emergency department triage nurses.Clinical Nursing Research
4. Dallaire, C.,Poitras, J.,Aubin, K.,Lavoie, A.,Moore, L.(2012).Emergency department triage: Do experienced nurses agree on triage scores?.The Journal of Emergency Medical,42(6),736-740.
5. Dateo, J.(2013).What factors increase the accuracy and inter-rater reliability of the Emergency Severity Index among emergency nurses in triage adult patients?.Journal of Emergency Nursing,39(2),203-207.
6. Edwards, B.(2007).Walking in - Initial visualisation and assessment at triage.Accident and Emergency Nursing,15(2),73-78.
7. Fernandes, C.,Tanabe, P.,Gilboy, N.,Johnson, L.,Mc Nair, R.,Rosenau, A.(2005).Five-level triage: A report from the ACEP/ENA fivelevel triage task force.Journal of Emergency Nursing,31(1),39-50.
8. Gilboy N, Tanabe P, Travers D, & Rosenau, A. (2013). Emergency severity index (ESI): A triage tool for emergency department. Retrieved from http://www.ahrq.gov/professionals/systems/hospital/esi/index.html Accessed December 19, 2015.
9. Martin, A.,Davodspm, C. L.,Panik, A.,Buckenmyer, C.,Delpais, P.,Ortiz, M.(2014).An examination of ESI triage scoring accuracy in relationship to ED nursing attitudes and experience.Journal of Emergency Nursing,40(5),416-418.
10. Olofsson, P.,Gellerstedt, M.,Carlström, E. D.(2009).Manchester Triage in Sweden-Interrater reliability and accuracy.International Emergency Nursing,17(3),143-148.
11. Parenti, N.,Reggiani, M.,Iannone, P.,Percudani, D.,Dowding, D.(2014).A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System.International Journal of Nursing Studies,51(7),1062-1069.
12. Reay, G.,Rankin, J. A.(2013).The application of theory to triage decision-making.International Emergency Nursing,21(2),97-102.
13. Stanfield, L.M.(2015).Clinical decision making in triage: An integrative review.Journal of Emergency Nursing,41(5),396-403.
14. Storm-Versloot, M. N.,Ubbink, D. T.,Kappelhof, J.,Luitse, J. S.(2011).Comparison of an informally structured triage system, the emergency severity index, and the Manchester triage system to distinguish patient priority in the emergency department.Academic Emergency Medicine,18(8),822-829.
15. Twomey, M.,Qallis, L. A.,Myers, J. E.(2007).Limitations in validating emergency department triage scales.Emergency Medicine Journal,24(7),477-479.
16. Wolf, L.(2010).Acuity assignation an ethnographic exploration of clinical decision making by emergency nurses at initial patient presentation.Advanced Emergency Nurses Journal,32(3),234-246.
17. Yeh, S. Y.,Bullard, M. J.,Hu, P. M.,Liao, H. C.,Chin, H. K.,Wang, W. C.,Liaw, S. J.(2008).An evaluation of the Taiwan triage scale in a regional hospital.Journal Emergency Critical Care Medicine,19(3),102-112.
18. 江錦玲、蔡芸芳(1999)。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之探討。慈濟醫學，11(3)，255-262。
19. 林增記(2010)。急診掛號不再是先到先看─五級檢傷分類判別先後順序。高醫醫訊，30(7)，5。
20. 社團法人台灣急診醫學會檢傷分類工作小組(2015，11 月24 日)．急診五級檢傷分類基準． 取自http://www.sem.org.tw/tsem/?doActionValueID=1535&menuID=1179069063&doAction=detail#none. [Taiwan Society of Emergency Medicine. (2015, November) Emergency 5-level triage criteria. Retrieved from http://www.sem.org.tw/tsem/?doActionValueID=1535&menuID=1179069063&doAction=detail#none.]
21. 邱曉彥、陳麗琴、林琇珠、桑潁潁、康巧娟、邱艷芬(2008)。台灣急診檢傷新趨勢─五級檢傷分類系統。護理雜誌，55(3)，87-91。
22. 邱曉彥、陳麗琴、邱艷芬(2010)。E 化五級檢傷分類系統教育訓練對檢傷護理人員之影響。長庚護理，21(4)，430-411。
23. 曹麗英校閱(2012)。急症護理。台北=Taipei City, Taiwan, ROC:新文京=New Wun Ching。
24. 陳淑貞 (2007)。台中市=Taichung，弘光科技大學護理研究所=Hungkuang University。
25. 陳淑新(2007)。台北醫學大學護理學研究所=Taipei Medical University。
26. 黃集仁(2006)。急診檢傷分類國際發展趨勢與國內因應策略。台灣急診檢傷與急迫度分級量表研習會，台北=Taipei City, Taiwan, ROC.:
27. 衛生福利部(2013，6 月25 日)．急診五級檢傷分類基準． 取自http://www.mohw.gov.tw/CHT/DOMA/DM1_P.aspx?f_list_no=608&fod_list_no=945&doc_no=1886 [Ministry of Health and Welfare. (2013, June)Emergency 5-level triage criteria. Retrieved from http://www.mohw.gov.tw/CHT/DOMA/DM1_P.aspx?f_list_ no =608&fod_list_no=945&doc_no=1886]
28. 簡杏津(2013)。台中市=Taichung，東海大學工業工程與經營資訊學系研究所=Tunghai University。