Journal of Health Promotion Management
فصلنامه مدیریت ارتقای سلامت
JHPM
Medical Sciences
http://jhpm.ir
1
admin
2251-8614
2251-9947
10.22034/jhpm
2251-8614
fa
jalali
1392
4
1
gregorian
2013
7
1
2
3
online
1
fulltext
fa
شیوع خطای تریاژ و پیامدهای تریاژ سبک در بیماران مراجعه کننده به بخش اورژانس
Prevalence of miss triage and outcomes under triage of patients in emergency department
مدیریت پرستاری
nursing management & administration
پژوهشي
Research
<font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt unicode-bidi: embed direction: rtl" dir="rtl"><b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">مقدمه</span></b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">:</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">تریاژ برای ارزیابی بالینی اولیه و دسته
بندی کلیه بیماران مراجعه کننده به بخش اورژانس جهت ارائه مناسب ترین درمان، ضروری
است. تریاژ صحیح و سریع بیماران کلید عملکرد موفق در بخش اورژانس است. این مطالعه
با هدف تعیین شیوع خطای تریاژ و پیامدهای تریاژ سبک در بیماران مراجعه کننده به
بخش اورژانس انجام شد.<b><o:p /></b></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt unicode-bidi: embed direction: rtl" dir="rtl"><b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">مواد و روش ها</span></b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">: در این پژوهش توصیفی، پرونده 300 بیمار مراجعه کننده به بخش اورژانس
بیمارستان های آموزشی وابسته به دانشگاه علوم پزشکی شهید بهشتی که در آن ها تریاژ
"نمایه وخامت اورژانس" (</span><span style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr">Emergency Severity Index</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"><span dir="rtl"></span><span dir="rtl"></span>)
به صورت فعال اجرا می شد؛ به روش تصادفی ساده انتخاب گردید. برای جمع آوری داده ها
از پرسشنامه حاوی اطلاعات جمعیت شناسی و فرم تریاژ براساس الگوریتم تریاژ
"نمایه وخامت اورژانس" استفاده شد. برای تعیین روایی ابزار، از روش
روایی صوری و برای</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">پایایی از روش همبستگی بین مشاهده
کنندگان (85/0) استفاده شد. تجزیه و تحلیل داده ها توسط نرم افزار </span><span style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr">SPSS</span><span dir="rtl"></span><span dir="rtl"></span><span style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="3"><font face="B Mitra">نسخه
17 انجام گردید.<o:p /></font></font></span></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt unicode-bidi: embed direction: rtl" dir="rtl"><b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">یافته ها:</span></b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"> در این مطالعه میزان تریاژ سبک 7/23 درصد و میزان تریاژ سنگین 7/11 درصد بود.
بیشترین میزان تریاژ سبک در سطح 3 تریاژ "نمایه وخامت اورژانس" بود. خطر
مرگ در اثر تریاژ سبک (با اطمینان 95 درصد) 2/3 برابر بیشتر از گروه تریاژ صحیح و
تریاژ سنگین بود. بعلاوه، همبستگی معنی داری بین خطای تریاژ و زمان انتظار بیمار
تا معاینه توسط پزشک اورژانس <font face="B Mitra"><font size="3"><span style="mso-spacerun: yes"> </span>(39/0</font></font></span><span style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr">P=</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"><span dir="rtl"></span><span dir="rtl"></span>)،
طول بستری بیمار در بیمارستان (77/0</span><span style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr">P=</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"><span dir="rtl"></span><span dir="rtl"></span>)<font size="3"><font face="B Mitra"><span style="mso-spacerun: yes"> </span>و نیز<span style="mso-spacerun: yes"> </span>بین خطای تریاژ و زمان بستری بیمار در بخش اورژانس (50/0</font></font></span><span style="line-height: 125% font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra"" dir="ltr">P=</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA"><span dir="rtl"></span><span dir="rtl"></span>)
یافت نشد.<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt unicode-bidi: embed direction: rtl" dir="rtl"><b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">نتیجه گیری: </span></b><span lang="FA" style="line-height: 125% font-family: "B Mitra" font-size: 12pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-bidi-language: FA">میزان خطای تریاژ از آستانه قابل قبول بالاتر است. در این پژوهش انجام تریاژ
صحیح و یا همراه با خطای تریاژ، تاثیری بر شاخص های زمانسنجی نداشته است. <o:p /></span></p><font face="Times New Roman" size="3"> </font>
<font face="Times New Roman" size="3"> </font><p class="yiv949092931msonormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt"><font size="3"><font face="Times New Roman"><b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">Introduction:</span></b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra""> To achieve the most suitable
treatment, triage is essential for the first clinical evaluation and
classifying all patients referring to the emergency department. Accurate and
rapid triage of patients is the key to a successful performance of emergency
departments. This study aimed to determine </span><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US">prevalence of miss triage and outcomes under
triage of patients in</span><span dir="rtl"></span></font><span style="font-family: "B Mitra" mso-ansi-language: EN-US" dir="rtl"><span dir="rtl"></span> </span><font face="Times New Roman"><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US">emergency
department</span><span dir="rtl"></span></font><span lang="AR-SA" style="font-family: "B Mitra"" dir="rtl"><span dir="rtl"></span>.</span><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra""><o:p /></span></font></p><font face="Times New Roman" size="3"> </font><p class="yiv949092931msonormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt"><font size="3"><font face="Times New Roman"><b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">Materials and Methods:</span></b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra""> In this descriptive study, a
total of 300 files were randomly selected among patients referred to the
emergency department of the hospitals that are educationally related to the </span><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US">Shahid Beheshti
University of Medical Sciences </span><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">where "Emergency Severity Index" (</span><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US">ESI) was
actively implemented</span><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">.
Data was collected by demographics information and triage form based on triage
algorithm "Emergency Severity Index". To determine the validity, face
validity and reliability of the </span><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US">ESI </span><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">was measured by inter-rater observation (0.85).</span><span dir="rtl"></span></font><span lang="EN-CA" style="font-family: "B Mitra"" dir="rtl"><span dir="rtl"></span> </span><span dir="ltr"></span><span style="mso-bidi-font-family: "B Mitra" mso-ansi-language: EN-US"><span dir="ltr"></span><font face="Times New Roman"><span style="mso-spacerun: yes"> </span>Data were
analyzed by SPSS/17.<o:p /></font></span></font></p><font face="Times New Roman" size="3"> </font><p class="yiv949092931msonormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt"><font size="3"><font face="Times New Roman"><b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">Findings:</span></b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra""> The under triage of 23.7% and over
triage of 11.7% were assessed in the research. The largest amount of under
triage was at the ESI level 3. Dying risk of under triage (with 95%) was 3.2
times higher than accurate triage and over triage. In addition, there was no
meaningful statistical difference for the average period of hospitalization</span><span dir="rtl"></span></font><span lang="EN-CA" style="font-family: "B Mitra"" dir="rtl"><span dir="rtl"></span> </span><span dir="ltr"></span><span lang="EN-CA" style="mso-bidi-language: FA mso-bidi-font-family: "B Mitra""><span dir="ltr"></span><font face="Times New Roman">(P=0.77)</font></span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" mso-bidi-language: FA" dir="rtl"><span dir="rtl"></span>,</span><span lang="FA" style="font-family: "B Mitra"" dir="rtl"> </span><font face="Times New Roman"><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">duration of
hospitalization at the emergency department </span><span lang="EN-CA" style="mso-bidi-language: FA mso-bidi-font-family: "B Mitra"">(P=0.50) </span><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">and waiting time for the
initial examination </span><span lang="EN-CA" style="mso-bidi-language: FA mso-bidi-font-family: "B Mitra"">(P=0.39)</span><span dir="rtl"></span></font><span lang="EN-CA" style="font-family: "B Mitra" mso-bidi-language: FA" dir="rtl"><span dir="rtl"></span>
</span><font face="Times New Roman"><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">by the emergency
physician in triage group comparing the under triage group.</span><span lang="AR-SA" style="font-family: "B Mitra"" dir="rtl"><o:p /></span></font></font></p><font face="Times New Roman" size="3"> </font><p class="yiv949092931msonormal" style="margin: 0in 0in 0pt text-align: justify line-height: 125% text-indent: 11.35pt"><font size="3"><font face="Times New Roman"><b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra"">Conclusion:</span></b><span lang="EN-CA" style="mso-bidi-font-family: "B Mitra""> Findings showed that the degree of miss
triage is higher than the acceptable threshold and doing an accurate triage or
along with miss triage doesn’t have any impacts on the timing indicators.<o:p /></span></font></font></p><font face="Times New Roman" size="3"> </font>
خطای تریاژ، تریاژ سبک، اورژانس
Miss triage, Under triage, Emergency.
17
23
http://jhpm.ir/browse.php?a_code=A-10-205-1&slc_lang=fa&sid=1
F
Kamrani
فرهاد
کامرانی
10031947532846001831
10031947532846001831
No
گروه داخلی و جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
F
Ghaemipour
فائزه
قائمی پور
f.ghaemipour@gmail.com
10031947532846001832
10031947532846001832
Yes
گروه داخلی و جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
M
Nikravan
ملاحت
نیکروان
10031947532846001833
10031947532846001833
No
گروه داخلی و جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
H
Alavi Majd
حمید
علوی مجد
10031947532846001834
10031947532846001834
No
گروه آمار زیستی، دانشکده پیراپزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.