The impact of the five-level Manchester Triage System on the admission of patients in the emergency department

Števila bolnikov v ambulantah nujne medicinske pomoči (ANMP) ni možno v naprej načrtovati, zato lahko postanejo razpoložljivi resursi v določenem trenutku preobremenjeni in zaradi tega pride do velikega tveganja glede varnosti bolnikov. Opisali smo različne modele triaže bolnikov, njihovo zanesljivost in kvaliteto odnosa med triažno medicinsko sestro in bolnikom. Želeli smo ugotoviti, kakšno je trenutno stanje izvajanja triaže bolnikov v večjih slovenskih ANMP. Prav tako smo želeli ugotoviti, ali je Manchesterski sistem triaže (MST) zanesljiv triažni sistem, ki zagotavlja pravočasno obravnavo bolnikov v ANMP glede na nujnost njihovega zdravstvenega stanja. Zanimalo nas je tudi, če je triažna medicinska sestra vzpostavila kvaliteten odnos z bolniki, ki jih triažira. Raziskovalna metodologija: Od devetih strokovnih vodij večjih ANMP v Sloveniji smo pridobili podatke o triažiranju. Za ugotavljanje zanesljivosti modela MST smo uporabili 20 scenarijev nujnih stanj, ki smo jih razdelili 30 medicinskim sestram. Za uvrstitev v triažne kategorije so uporabljale modela MST in Avstralsko-azijski sistem triaže (AST) ter lokalne protokole. Iz dobljenih odgovov smo naredili matrice nejasnosti, usklajenost ocenjevalk pa smo vrednotili s kappa. Iz ANMP Maribor smo pridobili podatke o 300 bolnikih, obravnavanih v obdobju od decembra 2010 do februarja 2011. Na osnovi primerjave med dejanskimi časi čakanja do obravnane in teoretičnimi časi ob odsotnosti triaže smo ocenili tveganje brez MST in zagotavljanje pravočasne obravnave ob uporabi MST. Razlike med skupinama smo testirali z Mann-Whitney U-testom. Rezultati: V Sloveniji se izvaja triaža po uveljavljenih modelih le v eni tretjini v raziskavi zajetih ANMP. Vse medicinske sestre so z uporabo modela MST pravilno uvrstile bolnike iz scenarijev. Z uporabo modela MST pravočasna obravnava sicer ni zagotovljena, se pa skrajšajo čakalni časi in verjetnost pravočasne obravnave je večja. Odnos medicinskih sester do bolnikov v ANMP je bil ocenjen kot zelo dober. Odstopanja so bila edino pri možnostih soodločanja, možnostih razgovora o težavah med obravnavo in občutku varnosti bolnika med obravnavo. Sklep: Pri slehernem bolniku, ki obišče ANMP, je potrebno izvesti triažo. Ministrstvo za zdravje je leta 2010 izdalo sklep, ki obvezuje vse ANMP k izvajanju triaže. Pričeli smo z licenciranim izobraževanjem za triažne medicinske sestre s strani Zbornice zdravstvene in babiške nege ter Ministrstva za zdravje. Proces triaže je potrebno nadgraditi z informacijskim sistemom ter tako doseči poleg nadzora bolnikov v čakalnici tudi nadzor v prostorih ANMP. V proces triaže je potrebno vedno vključevati tudi elemente humanih medsebojnih odnosov in skrbi za bolnike.The number of patients in emergency departments (ANMP) at any given moment cannot be preplanned. Available resources can therefore become overloaded, which may compromise the patients health and safety. In this Master’s thesis we describe different triage models, their reliability, and relationship quality between triage nurses and their patients. We determinet the current status of triage systems in larger ANMP’s in Slovenia. Furthermore, we wanted to establish, whether the Manchester triage system (MST) is a reliable model, which ensures timely management of patients in ANMP’s in accordance with the severity of their health status. Additionally, we wanted to know whether triage nurses establish a good relationship with their patients. Research methodolgy: We gathered information on the triage procedure from nine team leaders of larger ANMP\u27s in Slovenia. The reliability of the MST model was tested using 20 triage scenarios. We asked 30 triage nurses to assess these scenarios using the MST, Austral-Asian triage system (AST) and local protocols. We constructed confusion matrices and used the Kappa statistics to assess interrater reliability. From ANMP Maribor we received data on 300 patients, which were treated between December 2010 and February 2011. We compared waiting times for treatment with theoretical waiting times, in the absence of any king of triage. Differences were assessed using Mann-Whitney U-test. Results: Only a third of the ANMP’s included in this study perform triage in accordance with an established model. Using the MST model, all nursed were able to correctly classify the scenarios. While the MST does not ensure a timely treatment, waiting times can be shortened and the probability of being treated in time increases. In overall the relationship between triage nurses and their patients was appraised as good. Discrepancies were present in the patient’s option of making decisions themselves, the option of discussing problems during treatment, and the patient’s feeling of safety during treatment. Conclusions: Triage must be performed on all patients visiting the ANMP. This was also decreed by the Ministry of health in 2010. A licensed education for triage nurses was implemented by the Chamber of nurses and midwives, and the Ministry of health. It is necessary that triage systems be upgraded with an information system, in order to better monitor patients in waiting rooms, as well as in ANMP treatment rooms. The triage process should always include elements of “caring”, i.e. interpersonal relationship and care for patients