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Article
Publication date: 25 May 2021

Saqer Althunayyan, Abdullah Alhalybah, Ahmed Aloudah, Osama A. Samarkandi and Anas A. Khan

Simple Triage and Rapid Treatment (START) is a unique triage system used by prehospital providers during disasters to quickly categorize and prioritize patient care…

Abstract

Purpose

Simple Triage and Rapid Treatment (START) is a unique triage system used by prehospital providers during disasters to quickly categorize and prioritize patient care according to severity. This study aims at evaluating knowledge about the START triage system among field emergency medical service (EMS) personnel working at the Saudi Red Crescent Authority (SRCA) in the stations of the city of Riyadh.

Design/methodology/approach

This is a cross-sectional study that examined data collected from August 2019 to January 2020. The statistical population is from all field EMS personnel working in the SRCA located in Riyadh, Saudi Arabia. Using simple random sampling, 239 field EMS personnel were assessed, and 235 completed the study (98.3% response rate). Data were collected electronically using demographics and 15 multiple choice emergency scenarios based on the START protocol.

Findings

The mean correct score is 8.21 ± 3.36 out of 15 questions of triage knowledge (score of 0–15 points), indicating that those respondents have moderate knowledge levels on the START triage tool. Physicians and paramedics have higher mean scores (10.13 ± 3.42 and 9.07 ± 3.22, respectively), which are significantly higher than emergency medical technicians and nurses (7.25 ± 3.15 and 5.63 ± 2.72, respectively; p < 0.05). The providers who attended the training course had higher mean scores (p < 0.05).

Originality/value

Based on the results of the study, field EMS personnel did not reflect full knowledge of START triage tool. An interdisciplinary approach that adopts reinforcement education and periodical training courses is highly recommended to improve the respondents' performance and productivity. Moreover, there was a noticeable correlation between performance of respondents on the one hand and their education levels and prior training on the other hand.

Details

International Journal of Emergency Services, vol. 10 no. 3
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 16 October 2018

Lorella Cannavacciuolo, Adelaide Ippolito, Cristina Ponsiglione, Gaetano Rossi and Giuseppe Zollo

This paper aims to investigate the performances of decision-making process of emergency department’s nurses involved in the triage level assessment.

Abstract

Purpose

This paper aims to investigate the performances of decision-making process of emergency department’s nurses involved in the triage level assessment.

Design/methodology/approach

The authors developed a case study in two public hospitals in the South of Italy. The authors administered 25 clinical cases to nurses responsible of priority code assignment in the triage station. The authors simulated the attribution of the priority levels, and through a semi-structured questionnaire, the authors collected data and information about the cognitive process adopted for the final choice.

Findings

The quantitative and qualitative data allowed the authors to verify that there is an impact of the organizational context on heuristics used in the decision-making process.

Research limitations/implications

The research limitations are that empirical data have been collected only in two emergency departments.

Practical implications

The practical implications of this paper are that organizations for improving business performances must consider the judgements are often the results of heuristics embedded in a specific structure of social and physical environment, according with the “ecological view” of rationality.

Originality/value

The authors’ methodological approach contributes to analyze the performances of the triage process, verifying if the eventual errors are linked to individual or organizational factors, but above all how organizational constraints influence decision-making processes in organizations and, consequently, business performances.

Details

Measuring Business Excellence, vol. 22 no. 4
Type: Research Article
ISSN: 1368-3047

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Article
Publication date: 9 August 2018

Cristina Ponsiglione, Adelaide Ippolito, Simonetta Primario and Giuseppe Zollo

The purpose of this paper is to explore the configuration of factors affecting the accuracy of triage decision-making. The contribution of the work is twofold: first, it…

Abstract

Purpose

The purpose of this paper is to explore the configuration of factors affecting the accuracy of triage decision-making. The contribution of the work is twofold: first, it develops a protocol for applying a fuzzy-set qualitative comparative analysis (fsQCA) in the context of triage decision-making, and second, it studies, through two pilot cases, the interplay between individual and organizational factors in determining the emergence of errors in different decisional situations.

Design/methodology/approach

The methodology adopted in this paper is the qualitative comparative analysis (QCA). The fuzzy-set variant of QCA (fsQCA) is implemented. The data set has been collected during field research carried out in the Emergency Departments (EDs) of two Italian public hospitals.

Findings

The results of this study show that the interplay between individual and contextual/organizational factors determines the emergence of errors in triage assessment. Furthermore, there are some regularities in the patterns discovered in each of the investigated organizational contexts. These findings suggest that we should avoid isolating individual factors from the context in which nurses make their decisions.

Originality/value

Previous research on triage has mainly explored the impact of homogeneous groups of factors on the accuracy of the triage process, without considering the complexity of the phenomenon under investigation. This study outlines the need to consider the not-linear relationships among different factors in the study of triage’s decision-making. The definition and implementation of a protocol to apply fsQCA to the triage process in EDs further contributes to the originality of the research.

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Article
Publication date: 11 December 2019

Dana Wilson-Kovacs

Building on the findings of a British Academy-funded project on the development of digital forensics (DF) in England and Wales, the purpose of this paper is to explore how…

Abstract

Purpose

Building on the findings of a British Academy-funded project on the development of digital forensics (DF) in England and Wales, the purpose of this paper is to explore how triage, a process that helps prioritise digital devices for in-depth forensic analysis, is experienced by DF examiners and police officers in four English police forces. It is argued that while as a strategy triage can address the increasing demand in the examination of digital exhibits, careful consideration needs to be paid to the ways in which its set-up, undertaking and outcomes impact on the ability of law enforcement agencies to solve cases.

Design/methodology/approach

The methodological approach adopted here builds on the ethnographic turn in criminology. The analysis draws on 120 h of ethnographic observations and 43 semi-structured interviews. Observational data of the working DF environment at each location and a systematic evaluation of internal documents, organisational settings and police priorities helped refine emergent analysis threads, which were analytically compared between sites and against the testimonies of members of different occupational groups to identify similarities and differences between accounts.

Findings

The findings emphasise the challenges in the triage of digital exhibits as they are encountered in everyday practice. The discussion focusses on the tensions between the delivery of timely and accurate investigation results and current gaps in the infrastructural arrangements. It also emphasises the need to provide police officers with a baseline understanding of the role of DF and the importance of clearly defined strategies in the examination of digital devices.

Originality/value

This paper aims to bridge policy and practice through an analysis of the ways in which DF practitioners and police officers in four English constabularies reflect on the uses of triage in DF to address backlogs and investigative demands. Highlighting the importance of digital awareness beyond the technical remit of DF units, it offers new insights into the ways in which police forces seek to improve the evidential trail with limited resources.

Details

Policing: An International Journal, vol. 43 no. 1
Type: Research Article
ISSN: 1363-951X

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Article
Publication date: 27 November 2019

Mike Brady

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to…

Abstract

Purpose

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research.

Design/methodology/approach

Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database.

Findings

A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality.

Research limitations/implications

Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias.

Practical implications

The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles.

Originality/value

There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Details

International Journal of Emergency Services, vol. 9 no. 2
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 13 October 2014

Sarah Soppitt and Adele Irving

The purpose of this paper is to present a discussion of the value of early diversion schemes, underpinned by the principles of restorative justice (RJ), for First Time…

Abstract

Purpose

The purpose of this paper is to present a discussion of the value of early diversion schemes, underpinned by the principles of restorative justice (RJ), for First Time Entrants (FTEs) into the criminal justice system (CJS).

Design/methodology/approach

The paper focuses specifically on the findings of a 12-month study into the introduction of “Triage” by one Youth Offending Team (YOT) in the northeast of England.

Findings

Re-offending data suggested that Triage is more effective in reducing re-offending than conventional justice practices, due to the restorative nature of the scheme. However, the qualitative data raised a number of issues, particularly relating to problems of “net-widening” and the impact of recording processes on young people's desistance, as well as the role of victim engagement in the process. These issues could undermine the long-term effectiveness of Triage and its successful application within other youth justice contexts.

Originality/value

The paper aims to contribute further understanding regarding the impacts of RJ practices on reducing re-offending compared to traditional processes, and in particular, consider the role of implementation issues in the production of outcomes and impacts.

Details

Safer Communities, vol. 13 no. 4
Type: Research Article
ISSN: 1757-8043

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Article
Publication date: 8 February 2016

Ian Cummins and David Edmondson

In his recent report, Lord Adebowale (2013) described mental health issues as “core police business”. The recent retrenchment in mental health and wider public services…

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Abstract

Purpose

In his recent report, Lord Adebowale (2013) described mental health issues as “core police business”. The recent retrenchment in mental health and wider public services mean that the demands on the police in this area are likely to increase. Mental health triage is a concept that has been adapted from general and mental health nursing for use in a policing context. The overall aim of triage is to ensure more effective health outcomes and the more effective use of resources. The purpose of this paper is to examine the current policy and practice in this area. It then goes on to explore the models of mental health triage that have been developed to try and improve working between mental health services and the police.

Design/methodology/approach

The paper outlines the main themes in the research literature regarding mental illness and policing, including a brief overview of section 136 MHA. It then examines recently developed models of triage as applied in these settings.

Findings

The models of triage that have been examined here have developed in response to local organisational, demographic and other factors. The approaches have two key features – the improved training for officers and improved liaison with mental health services.

Practical implications

Wider mental health training for officers and improved liaison with community-based services are the key to improving police contacts.

Social implications

The current pressure on mental health services has increased the role that the police have in responding to these sorts of emergencies. This situation is unlikely to change in the short term.

Originality/value

This paper contributes to the wider debate about policing and mental illness. It highlights the fact that section 136 MHA use has tended to dominate debates in this area to the detriment of a broader discussion of the police role.

Details

The Journal of Adult Protection, vol. 18 no. 1
Type: Research Article
ISSN: 1466-8203

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Article
Publication date: 7 March 2016

Martin Kerridge-Weeks and Neil John Langridge

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient…

Abstract

Purpose

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.

Design/methodology/approach

A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.

Findings

In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.

Originality/value

Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.

Details

International Journal of Health Governance, vol. 21 no. 1
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 21 March 2016

Björn Lantz and Peter Rosén

The purpose of this paper is to show how elements from queueing theory can be used to obtain objective measures of effective capacity in the triage function at Skaraborg…

Abstract

Purpose

The purpose of this paper is to show how elements from queueing theory can be used to obtain objective measures of effective capacity in the triage function at Skaraborg Hospital in Sweden without direct observation of the function itself.

Design/methodology/approach

Approximately 30,000 patients arrived to the emergency department at Skaraborg Hospital in Sweden during 2011. The exact time of arrival and the exact time of triage were recorded for each patient on an individual level. Basic queueing theory uses arrival rates and system capacity measures to derive average queueing times. The authors use the theoretical relation between these three measures to derive system capacity measures based on observed arrival rates and observed average queueing times.

Findings

The effective capacity in the triage process is not a linear function of the number of nurses. However, the management of capacity seems well adapted to the actual demand, even though service levels vary substantially during the day and night.

Originality/value

This paper uses elements from queueing theory in an innovative way to measure the effective capacity of a service process without direct observation, thereby also avoiding the potential risk of the Hawthorne effect.

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Article
Publication date: 2 January 2019

M. Glòria Barberà-Mariné, Lorella Cannavacciuolo, Adelaide Ippolito, Cristina Ponsiglione and Giuseppe Zollo

The purpose of this paper is to investigate the influence of organizational factors on individual decision-making under conditions of uncertainty and time pressure. A…

Abstract

Purpose

The purpose of this paper is to investigate the influence of organizational factors on individual decision-making under conditions of uncertainty and time pressure. A method to assess the impact of individual and organizational factors on individual decisions is proposed and experimented in the context of triage decision-making process.

Design/methodology/approach

The adopted methodology is based on the bias-variance decomposition formula. The method, usually applied to assess the predictive accuracy of heuristics, has been adjusted to discriminate between the impact of organizational and individual factors affecting heuristic processes. To test the methodology, 25 clinical scenarios have been designed and submitted, through simulations, to the triage nurses of two Spanish hospitals.

Findings

Nurses’ decisions are affected by organizational factors in certain task conditions, such as situations characterized by complete and coherent information. When relevant information is lacking and available information is not coherent, decision-makers base their assessments on their personal experience and gut feeling.

Research limitations/implications

Discriminating between the influence of organizational factors and individual ones is the starting point for a more in-depth understanding of how organization can guide the decision process. Using simulations of clinical scenarios in field research does not allow for capturing the influence of some contextual factors, such as the nurses’ stress levels, on individual decisions. This issue will be addressed in further research.

Practical implications

Bias and variance are useful measurements for detecting process improvement actions. A bias prevalence requires a re-design of organizational settings, whereas training would be preferred when variance prevails.

Originality/value

The main contribution of this work concerns the novel interpretation of bias and variance concepts to assess organizational factors’ influence on heuristic decision-making processes, taking into account the level of complexity of decision-related tasks.

Details

Management Decision, vol. 57 no. 11
Type: Research Article
ISSN: 0025-1747

Keywords

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