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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 according to…

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

Keywords

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 triage

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

Keywords

Article
Publication date: 27 January 2021

Davina Allen

The purpose of this paper is to analyse the socio-material practices through which organisational understanding of patients is accomplished in order to prioritise calls and…

Abstract

Purpose

The purpose of this paper is to analyse the socio-material practices through which organisational understanding of patients is accomplished in order to prioritise calls and mobilise emergency medical services at the gateway of the healthcare system.

Design/methodology/approach

The methodology of this paper is an ethnographic study of the co-ordination of collective action in an emergency services control room in the Welsh NHS, with data generation and analysis informed by Translational Mobilisation Theory.

Findings

Mobilisation of emergency medical services entails the translation of callers' undifferentiated problems into response priority categories, which are used by dispatch operators to mobilise crews. A central actor in these processes is the computerised Medical Priority Dispatch System. While designed to enable non-clinically qualified call handlers to triage calls in a standardised way, the system constrains caller–call handler interaction, which negatively impacts the categorisation process. Analysis of these interactional difficulties and associated mitigation strategies highlights opportunities for intervening to support co-ordination at this healthcare boundary.

Originality/value

Orthodox approaches to improving interface management are founded on a conceptualisation of “patients” as immutable actors in care transfer processes. Translational Mobilisation Theory brings into view the multiple versions of the “patient” produced by healthcare systems and offers a framework for analysing the mechanisms of action necessary to create organisational understandings of patients at boundary crossings. While the ambulance control centre is a singular case, the paper illustrates the value of attending to these processes in interface organisation.

Open Access
Article
Publication date: 2 February 2022

Johan Hylander, Britt-Inger Saveman, Ulf Björnstig, Lina Gyllencreutz and Anton Westman

Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and…

Abstract

Purpose

Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and infrastructure owners. The aim of this paper is to investigate how collaborative partners to the ambulance services perceive the rescue effort and to identify factors that may influence its efficiency.

Design/methodology/approach

Focus group and individual interviews were conducted with 19 participants who were infrastructure owners or had operational or tactical responsibilities with the emergency services or EDCs in two regions in Sweden with multiple road tunnels. The collected data were analysed using qualitative content analysis.

Findings

Three main categories described efficiency factors during and after an incident: (1) coordinating the initial information (using a shared terminology), (2) achieving situational awareness (identifying those persons in need) and (3) lessons (not) learnt (lack of joint tactical plans and exercises). The emerging theme was access, assess and evaluate.

Practical implications

The findings suggest that establishing national policies and collaborative forums might yield more efficiently managed rescue efforts in road tunnel incidents in Sweden and other countries with similar organisational structures.

Originality/value

This study offers new insights on interoperability during responses to complex underground incidents.

Details

International Journal of Emergency Services, vol. 11 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

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 develops…

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.

Article
Publication date: 4 April 2023

Narender Nalajala, Mitesh Panchal and Laura Gotting

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK…

Abstract

Purpose

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK) services and introduced advance clinical practice, a multi-disciplinary team triage with a formalised straight to test (STT) process defined in 2018. Historically, prior to these services' integration, there were a primary and second care triage systems within individual specialities. The aim of this service evaluation is to assess the impact of a single IMSK multidisciplinary triage (MDT) system and the efficacy of STT from triage, which allows patients to be sent for diagnostics based on the cluster of symptoms and past medical history in order to achieve early identification of serious pathologies. This is a complex adaptive system with pathways spanning into the core areas of orthopaedics, rheumatology, therapies, pain management services, radiology and some less frequent specialities such as neurology, oncology, vascular and gynaecology. One of the objectives of this study was to identify how many referrals were triaged to consultants, Advance practice and therapies. In addition, the authors wanted to highlight the proportion of referrals that were sent straight to test from triage and the percentage of these that had sinister pathology identified. This information would then be compared against existing red flag literature to identify common themes. This study aims to discuss the aforementioned objectives.

Design/methodology/approach

Data were extracted retrospectively from a hospital database from January to December 2019 for all the adult musculoskeletal service referrals. The data collected were analysed on a Microsoft Excel sheet with information including date of triage, hospital number, ordering clinician, body part, type of diagnostic, indications for scanning, outcome for STT, serious pathology findings (named code 5 within our trust) and outcome of appointment.

Findings

A total of 47,039 referrals were received into the IMSK service. Of these referrals 19,967 were directly referred to therapies, with 27,072 referrals received into the IMSK service MDT process. Within triage, 718 patients were directed to STT to rule out serious pathology. A total of 28 patients (3.9%) had sinister pathology identified on their investigation. A total of 46% of patients were discharged from their first consultation following STT. Overall, 50% of the total number of referrals into the IMSK service was seen by advanced practitioners with 16% of patients directed to consultants with pre-consultation diagnostic work up.

Originality/value

This service evaluation highlights that STT allows early access to diagnostics, resulting in quicker access to identification of sinister pathology. A one stop MDT system has been shown to be effective in guiding the referral to the right place with increased referrals into allied health advance practice clinics and access to therapies directly. It has resulted in a reduction of unwarranted referrals to consultant care, duplication of investigations and identified patients on multiple pathways.

Details

Journal of Integrated Care, vol. 31 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

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

Keywords

Article
Publication date: 26 May 2022

Robert L. Bonner, Andrea R. Neely, Christopher B. Stone, Cynthia A. Lengnick-Hall and Mark L. Lengnick-Hall

The purpose of this paper is to provide an overarching framework to guide the understanding of the allocation and deployment of strategic human capital assets within an…

Abstract

Purpose

The purpose of this paper is to provide an overarching framework to guide the understanding of the allocation and deployment of strategic human capital assets within an organization. Using the concept of medical triage with business units analogous to “patients” and their performance to “symptoms or injuries,” the framework suggests a “steal from the poor” perspective that is counter to conventional organizational decline literature.

Design/methodology/approach

This is a conceptual paper proposing that there are five different categories of business unit need for human capital assets: expectant, deceased, immediate, delayed or minimal; all based on the type of environment and holistic performance of the business unit. Based on a business unit’s specific situation, the authors suggest a process model guiding how to conduct a triage analysis to optimize the allocation of strategic human capital assets within an organization.

Findings

The authors argue that current trends in assessing strategic human capital assets which make comparisons across organizations are necessary but insufficient (e.g. comparing a store to other stores in its district or region). Each business unit has its own unique internal capabilities and external constraints that also must be accurately assessed to make an informed organizational-level decision about where and how to deploy strategic human capital assets.

Originality/value

Borrowing from medical science, this paper demonstrates a new conceptual framework with propositions for researchers and guidance for practitioners.

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 determine…

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

Keywords

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