Implementation of Advanced Triage in the Emergency Department of Bellvitge University Hospital

NCT05230108 | Unknown DMC

• 1 other identifier: PR085/20
• Study Type: interventional
• Target: 547
• Locations: 1 country
• Sites: 1

Brief Summary

This study evaluates the efficacy of advanced triage in improving the quality of care outcomes of patients attending the Emergency Department (ED) united care of high complexity hospital. There are four steps; Step 1 will consist of a concept analysis. Step 2 will include a mapping of advanced practice protocol terminologies. Step 3 will analyse the opinion of health professionals on advanced triage. In step 4: in retrospective phase, sociodemographic and clinical variables and quality indicators such as waiting time will be analysed. After that, in the prospective phase, advanced triage will be implemented and the two cohorts will be compared.

Conditions

Nurse's Scope of Practice

Keywords

advanced practice nurse emergency; Advanced Interventions Nursing; Emergency Department.

Outcome Measures

Primary Outcomes (1)

• Quality indicators specific to triage.

  Set of peculiar traits that characterise someone or something. This variable is a composite variable which is made up of quality indicators specific to triage, waiting time, and variables to inform the sample. * Arrival/registration-triage time: The time from patient arrival at the ED to triage classification. Quality indicators define this time as \<= 10 minutes (min) over the total number of patients triaged. * Waiting time to be visited: It is established that at least 90% of patients must be visited by a medical team within \<= 120 min from their classification, and 100% within \<= 240 min

  Pre-intervention time as an initial reference.

Secondary Outcomes (4)

• Cluster:

  Throgh study completion, an average of 1 year.

• CatSalut-PLAENSA©

  12 months.

• Waiting times

  12 months.

• The Visual Analog Scale (VAS or EVA)

  12 months.

Study Arms (2)

Phase 1 (F1): retrospective control.

NO INTERVENTION

Phase 1, retrospective, will include all patients who attended the ED from January 2018 to December 2022.

Phase (F2): prospective intervention of Advanced Triage

EXPERIMENTAL

Phase 2, prospective, where advanced triage based on advanced practice nurse will be implemented. Will include patients from January 2023 to December 2024.

Procedure: Advanced Triage

Interventions

Advanced Triage PROCEDURE

Advanced triage is an intervention that allows the emergency nurse to resolve health problems of low clinical complexity. All actions are aimed at resolving a health problem based on a protocol previously agreed upon by a multidisciplinary team.

Also known as: Advanced triage is part of advanced practice nurse (APN).

Phase (F2): prospective intervention of Advanced Triage

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• over 18 years of age, admitted to EDs classified with Emergency Severity Index (ESI) severity levels III, IV and V.

You may not qualify if:

• patients over 70 years of age
• pregnant women
• patients with a Glasgow Glasgow score of less than 15
• patients with more than 3 chronic pathologies and/or 1 complex chronic
• disease or patients reconsulting the ED for the same reason for consultation.

Sponsors & Collaborators

• Hospital Universitari de Bellvitge: lead
• Official Barcelona Nurses Association (COIB): collaborator

Study Sites (1)

Hospital Universitari de Bellvitge

L'Hospitalet de Llobregat, Barcelona, 08907, Spain

Location

Related Publications (10)

• Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med. 2020 Jun 15;28(1):55. doi: 10.1186/s13049-020-00749-2.

  PMID: 32539739 BACKGROUND

• Bittencourt RJ, Stevanato AM, Braganca CTNM, Gottems LBD, O'Dwyer G. Interventions in overcrowding of emergency departments: an overview of systematic reviews. Rev Saude Publica. 2020;54:66. doi: 10.11606/s1518-8787.2020054002342. Epub 2020 Jul 3.

  PMID: 32638885 BACKGROUND

• Butti L, Bierti O, Lanfrit R, Bertolini R, Chittaro S, Delli Compagni S, Del Russo D, Mancusi RL, Pertoldi F. Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain. J Pain Res. 2017 Oct 16;10:2479-2488. doi: 10.2147/JPR.S138850. eCollection 2017.

  PMID: 29081670 BACKGROUND

• Hinson JS, Martinez DA, Schmitz PSK, Toerper M, Radu D, Scheulen J, Stewart de Ramirez SA, Levin S. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med. 2018 Jan 15;11(1):3. doi: 10.1186/s12245-017-0161-8.

  PMID: 29335793 BACKGROUND

• Innes K, Jackson D, Plummer V, Elliott D. Emergency department waiting room nurse role: A key informant perspective. Australas Emerg Nurs J. 2017 Feb;20(1):6-11. doi: 10.1016/j.aenj.2016.12.002. Epub 2017 Jan 17.

  PMID: 28108139 BACKGROUND

• Lauks J, Mramor B, Baumgartl K, Maier H, Nickel CH, Bingisser R. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay. PLoS One. 2016 Apr 22;11(4):e0154372. doi: 10.1371/journal.pone.0154372. eCollection 2016.

  PMID: 27104911 BACKGROUND

• Sarria-Guerrero JA, Luaces-Cubells C, Jimenez-Fabrega FX, Villamor-Ordozgoiti A, Isla Pera P, Guix-Comellas EM. Pediatric televisits and telephone triage: impact on use of a hospital emergency department. Emergencias. 2019 Ago;31(4):257-260. English, Spanish.

  PMID: 31347806 BACKGROUND

• Woo BFY, Lee JXY, Tam WWS. The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Hum Resour Health. 2017 Sep 11;15(1):63. doi: 10.1186/s12960-017-0237-9.

  PMID: 28893270 BACKGROUND

• Zachariasse JM, van der Hagen V, Seiger N, Mackway-Jones K, van Veen M, Moll HA. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open. 2019 May 28;9(5):e026471. doi: 10.1136/bmjopen-2018-026471.

  PMID: 31142524 BACKGROUND

• Font-Cabrera C, Juve-Udina ME, Galimany-Masclans J, Fabrellas N, Rosello-Novella A, Sancho-Agredano R, Adamuz J, Guix-Comellas EM. Implementation of advanced triage in the Emergency Department of high complexity public hospital: Research protocol. Nurs Open. 2023 Jun;10(6):4101-4110. doi: 10.1002/nop2.1622. Epub 2023 Jan 31.

  PMID: 36719704 DERIVED

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Cristina Font Cabrera, Nurse

CONTACT

+34 687 235 773; cristinafont@ub.edu

Eva Maria Guix Comellas, Nurse. PHD

CONTACT

+34 609 310 430; evaguix@ub.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Emergency Nurse

Model Details: The fourth step is a quasi-experimental study consisting of two phases: the first, a retrospective control phase, and the second, a prospective intervention phase in which advanced triage will be implemented. In phase 1, control, quality of care indicators will be assessed, based on quality indicators in the emergency department, waiting time and satisfaction, and the level of pain. In addition, different epidemiological, socio-cultural and clinical variables will be measured. In phase 2, the intervention phase, advanced triage will be implemented based on advanced practices nurse and the indicators of quality of care and pain will be assessed.

Study Record Dates

• First Submitted: December 22, 2021
• First Posted: February 8, 2022
• Study Start: September 1, 2022
• Primary Completion: December 31, 2024
• Study Completion: December 31, 2025
• Last Updated: February 8, 2022

Record last verified: 2022-02

Data Sharing

• IPD Sharing: Will not share

Locations

ES (1)