Validity and Reliability of ESI vs. Three-Tier Triage in ED
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Validity and Reliability of Emergency Severity Index and Conventional Three-Tier Triage System in the Emergency Department, Hospital Universiti Sains Malaysia
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
This page presents a generated summary with additional references; See source (below) for actual content.
Original source:
This page is merely a summary which is automatically generated hence you should visit the source to read the original article which includes the author, publication date, notes and references.
Ban Jin Victor Lim, Shaik Farid Ab Wahab, Yee Cheng Kueh
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Validity and Reliability of Emergency Severity Index and Conventional Three-Tier Triage System in the Emergency Department, Hospital Universiti Sains Malaysia
Year: 2020 | Doi: 10.21315/mjms2020.27.2.10
Copyright (license): CC BY 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Emergency Departments (EDs) often encounter overwhelming patient numbers, necessitating efficient triage systems to distinguish the critically ill from stable patients. This study aimed to evaluate the reliability and validity of two triage systems: the existing three-tier system used at Hospital Universiti Sains Malaysia (HUSM) and the Emergency Severity Index (ESI), a newer five-tier system. The study focused on the inter-rater reliability and effectiveness of these systems in accurately categorizing patient acuity to ensure timely medical intervention.
ESI's Enhanced Validity
The results indicated that the ESI triaging system demonstrated superior validity over the traditional three-tier system. While both systems exhibited substantial inter-rater agreement, with Cohen's Kappa scores of 0.81 for the three-tier and 0.75 for ESI, the ESI outperformed in terms of sensitivity (74.3% vs. 68.5%) and specificity (94.4% vs. 87.0%). Additionally, the ESI system resulted in lower under-triage (10.7% compared to 13.1%) and over-triage rates (6.2% vs. 17.1%), indicating its capability in better identifying patients who require urgent care while minimizing unnecessary resource allocation.
Conclusion
The study concluded that the ESI is a more effective triaging tool for emergency departments compared to the conventional three-tier triage system. Although both systems showed comparable inter-rater reliability, ESI's higher sensitivity and specificity, coupled with lower rates of misclassification, support its implementation in HUSM's ED. Regular training and refinement in the ESI process are vital for maintaining proficiency among paramedics and improving triage accuracy over time. Such advancements in triage systems can lead to better patient outcomes and optimized resource usage in emergency medical settings.
FAQ section (important questions/answers):
What was the aim of the study conducted in HUSM's ED?
The study aimed to evaluate the reliability and validity of both the existing three-tier triaging system and the new five-level Emergency Severity Index (ESI) in the Emergency Department (ED) of Hospital Universiti Sains Malaysia (HUSM).
How were patients triaged during the study periods?
In the first three months, 300 patients were triaged using the three-tier system. In the subsequent three months, 280 patients were triaged under the ESI, with records compared between junior and senior paramedics to assess accuracy.
What were the results regarding inter-rater reliability of the systems?
The three-tier triaging system had an inter-rater agreement of 0.81, while the ESI showed an agreement of 0.75. Both systems exhibited good reliability, but the three-tier system performed slightly better.
What conclusions can be drawn about the ESI's effectiveness?
The study concluded that the ESI is a superior triaging tool compared to the three-tier system, demonstrating better sensitivity and specificity in assessing patient acuity, essential for timely treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Validity and Reliability of ESI vs. Three-Tier Triage in ED”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
Table refers to a structured arrangement of data, often presented in rows and columns, to facilitate comparison and analysis. In research, tables effectively summarize important findings, allowing readers to quickly grasp patterns, statistics, and trends, enhancing the overall understanding of the study's results and implications for practice.
2) Study (Studying):
A study pertains to a systematic investigation aimed at discovering or compiling knowledge. In the context of research, it evaluates hypotheses or analyzes data to derive conclusions about a specific issue. This study investigated the effectiveness of triaging systems in emergency departments, impacting clinical practices and patient outcomes.
3) Reliability:
Reliability refers to the consistency and dependability of a measure or assessment tool. In research, high reliability indicates that repeated measurements yield stable results. It is crucial for ensuring that study findings are trustworthy and can be reproduced, particularly in medical contexts where precision can significantly affect patient care and safety.
4) Kappa:
Kappa is a statistical measure used to assess inter-rater agreement, quantifying how much agreement there is beyond what would be expected by chance. High Kappa values indicate strong agreement between different raters, making it a vital metric for determining the reliability of assessments, especially in clinical settings like triage.
5) Training:
Training involves imparting skills and knowledge to enhance competence in specific tasks or roles. In medical contexts, training is essential for ensuring staff, like paramedics, are proficient in various procedures, such as triage systems, which directly influences patient care effectiveness and the overall efficiency of emergency services.
6) Rules:
Rules are established guidelines or principles that dictate how processes should be conducted. In the context of medical triage, rules govern the classification of patients according to severity, ensuring that care is prioritized appropriately. Adherence to these rules can notably enhance the flow and effectiveness of patient management.
7) Relative:
Relative refers to a measure or concept that is determined by its relation to something else. In clinical settings, a relative comparison of cases, resources, or outcomes is essential for understanding the significance of findings and their implications on health interventions, allowing for more informed decision-making processes.
8) Quality:
Quality indicates the standard or degree of excellence of a service, material, or measurement. In healthcare, quality assessment is critical, particularly in emergency departments, as it directly impacts patient safety and treatment outcomes. High-quality systems ensure effective triaging, resource utilization, and patient satisfaction, forming a cornerstone of healthcare improvement.
9) Sign:
Sign refers to an indicator or manifestation that reflects a certain condition or state. In medical contexts, patient signs observed during evaluations are crucial for diagnosis and treatment planning. Recognizing the right signs can lead to timely interventions, significantly affecting outcomes in emergency situations.
10) Knowledge:
Knowledge encompasses the information, understanding, and skills gained through experience or education. In healthcare, up-to-date knowledge is essential for practitioners to make informed decisions, particularly in dynamic environments such as emergency departments. Knowledge retention and application can dramatically influence patient assessment and management processes.
11) Teaching:
Teaching is the act of imparting knowledge or skills through instruction. In medical settings, effective teaching is critical for training healthcare professionals on processes like triaging, ensuring they are equipped to make timely, accurate decisions that enhance patient care quality and safety in emergency situations.
12) Mitra:
Mitra refers to a person or potentially a study that could influence learning or practice in the context of medical triage. The relevance involves using research findings to highlight best practices, thereby contributing to effective training and improving the overall efficiency in emergency medical settings.
13) Storm:
Storm refers to potential disturbances or challenges that may affect operations in emergency environments. In medical triage, understanding such disruptions helps teams prepare and adapt strategies to ensure efficient patient care under pressure. Identifying storm factors enhances resource allocation and risk management in emergencies, improving resilience.
14) Jacob:
Jacob could denote a researcher, individual, or concept relevant to the study or context of medical triage. This association signifies the importance of diverse expertise and perspectives in enhancing understanding and implementation of effective triage systems, contributing to better patient care and operational efficiency.
15) Java:
Java may refer to a geographical location, in this case, East Java, Indonesia, which possibly relates to the study of healthcare practices in different cultural or logistical settings. Understanding regional differences in triaging systems emphasizes the need for adaptable practices tailored to specific populations and environments.
16) Wall:
Wall symbolizes barriers or boundaries that might hinder efficient communication or processes in emergency care. Recognizing and addressing these walls in a clinical context can promote better interdisciplinary collaboration and improve overall patient management, particularly in high-stress environments like emergency departments.
17) Gold (Golden):
Gold usually refers to a standard of excellence used for benchmarking quality. In research, a 'gold standard' is a measurement or benchmark considered the most accurate. Establishing gold standards in medical triage practices ensures reliability and validity, essential for effective patient outcomes and operational success.
18) Post:
Post refers to the subsequent process or position after a particular action occurs. In a medical study context, post-implementation analysis is crucial for evaluating the effectiveness of newly introduced procedures or guidelines, aiding in continuous quality improvement and refinement of patient care strategies in emergency departments.
19) Male:
Male pertains to gender classification relevant in medical studies, often affecting health interventions, presentations, or outcomes. In triage processes, understanding gender disparities is essential for tailoring interventions accurately, ensuring effective treatment delivery and addressing gender-specific health needs regarding both acute and chronic conditions.
20) Life:
Life refers to the condition that distinguishes animals and plants from inorganic matter. In healthcare, preserving life is a fundamental objective, guiding triaging decisions to prioritize patients most in need. Effective triage directly correlates with improved survival rates and quality of life outcomes in emergency care settings.
21) Measurement:
Measurement signifies the process of obtaining data to quantify attributes or parameters. In clinical practice, accurate measurements are crucial for confident triage assessments. The ability to quantify patient acuity levels ensures that appropriate resources are allocated timely, enhancing the delivery of care in emergency departments.
22) Discussion:
Discussion encompasses critical evaluation and interpretation of findings within a study. In medical research, a comprehensive discussion is essential for contextualizing results, addressing limitations, and proposing practical recommendations. This element fosters a deeper understanding among practitioners, guiding future improvements and strategies in emergency medical settings.
23) Practising (Practicing):
Practicing refers to the act of engaging routinely in an activity or profession. In healthcare, consistent practicing of effective triage protocols is crucial for developing skills and ensuring high-quality patient care. It fosters ongoing learning and adaptation to emerging healthcare challenges and best practices within emergency environments.
24) Annamalai:
Annamalai likely denotes an individual associated with the study or particular methodological contribution. Recognizing individuals like Annamalai emphasizes the collaborative nature of research in improving medical practices, particularly in emergency care, showcasing the interdependence of diverse expertise in enhancing overall patient safety and care quality.
25) Attending:
Attending signifies the active participation of healthcare professionals in patient care processes. An attending physician plays a vital role in emergency care, overseeing patient assessments and triaging effectiveness. Their involvement ensures adherence to best practices, elevating the standard of care delivered to patients in critical conditions.
26) Medicine:
Medicine encompasses the science and practice of diagnosing, treating, and preventing illness. In triaging systems, effective application of medical knowledge is critical for accurate patient assessments, ensuring timely interventions and optimized resource use in emergency departments, profoundly impacting patient outcomes and overall health system efficiency.
27) Dressing:
Dressing refers to a protective covering applied to a wound. In emergency medicine, appropriate dressing techniques are vital for preventing infection and promoting healing. Knowledge of dressing application is essential for medical professionals during triage, ensuring optimal initial care and influencing patient recovery trajectories.
28) Reason:
Reason relates to the rationale or justification for actions taken in practice. In medical triage, understanding the underlying reasons for prioritizing certain patients informs decision-making processes, enhancing the efficiency of care provided and ensuring that the most critically ill patients receive appropriate and timely interventions.
29) Indian:
Indian references a nationality or ethnicity relevant in healthcare research, especially regarding patient demographics and health interventions. Understanding culturally specific health issues among Indian populations can help tailor triage protocols and improve patient outcomes by addressing unique medical needs in diverse community settings.
30) Chang:
Chang could signify an individual or element of influence in medical contexts, particularly related to the study. Recognizing contributions from Chang encourages the acknowledgement of diverse voices and perspectives in improving emergency care practices, fostering collaboration among professionals to enhance overall triage and patient handling systems.
31) Visit:
Visit denotes instances of patients seeking medical care or treatment. Understanding visit patterns in emergency departments helps in assessing triage system effectiveness and resource allocation. Insights gained from patient visit data can inform improvements in care delivery, ensuring that systems efficiently manage patient flow and minimize wait times.
32) Blood:
Blood is a crucial bodily fluid involved in various physiological processes and often a critical parameter in emergency assessments. In triaging, the evaluation of blood-related issues can determine the urgency of care required. Timely blood tests or transfusions significantly impact treatment decisions and patient outcomes in emergencies.
33) Cina:
China refers to a nation with significant healthcare dynamics that may be relevant in comparative medical studies. Understanding triaging systems in the context of healthcare policies, culture, and practices in China can provide valuable insights for improvements in emergency care frameworks, enriching global healthcare perspectives and innovations.
34) Crowd:
Crowd denotes gatherings of people, which can significantly impact medical environments, particularly in emergency departments. High crowd levels can exacerbate clinical challenges, making efficient triage essential for ensuring timely patient care. Effective crowd management strategies can improve patient flow and outcomes during emergencies.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Validity and Reliability of ESI vs. Three-Tier Triage in ED’. Further sources in the context of Science might help you critically compare this page with similair documents:
Critical condition, Patient care, Patient's condition, Hospital admission, Purposive Sampling Method, Clinical condition, Inter-rater reliability, Patient characteristics, Study period, Sensitivity and Specificity, Emergency Department, Positive predictive value, Negative predictive value, Patient Outcome, Severity level, Discharge rate, Predictive value, Expert panel, Training session, Hospital admission rate.