EMJ Podcast September 2021

Author: Andrew Tabner, Graham Johnson / Codes: SLO10 / Published: 24/09/2021

Paper Title

Ability of triage nurses to predict, at the time of triage, the eventual disposition of patients attending the emergency department (ED): a systematic literature review and meta-analysis

Paper Authors

1. Michael Anis Mihdi Afnan, 

2. Tejas Netke, 

3. Parminder Singh, 

4. Helena Worthington, 

5. Fatima Ali, 

6. Changavy Kajamuhan, 

7. Arjan Nagra

Link to Paper

Ability of triage nurses to predict, at the time of triage, the eventual disposition of patients attending the emergency department (ED): a systematic literature review and meta-analysis (bmj.com)

What is already known on this subject

  • Multiple observational studies have been performed across different settings to determine the accuracy of triage nurse prediction of emergency patient disposition. 
  • Results have been variable across studies.

What this study adds

This paper reports a meta-analysis of observational studies which finds triage nurse prediction of disposition is not sufficiently accurate to aid admission planning on a one-to-one basis.

Study Design

Systematic Review and meta-analysis

What was assessed?

Participants—adult ED patients. 

Index test—triage nurse prediction of disposition (admission or discharge). 

Comparison (reference standard) test—actual eventual patient disposition. 

Outcome: admission or discharge. Study design: prospective observational studies.

Outcomes

10 studies included and performed a meta-analysis on seven of these (12,282 participants).

The studies varied in participant selection and admission rate, but the majority were of moderate quality and exclusion of each in sensitivity analyses made little difference. Sensitivity was 72% and specificity was 83%. Pretest probability of admission was 29%. Positive and negative post-test probabilities of admission were 63% and 12%, respectively

Authors’ Conclusion

Triage nurse prediction of disposition is not accurate enough to expedite admission for ED patients on a one-to-one basis. Future research should explore the benefit, and best method, of predicting total demand

Limitations

Heterogeneity of papers – varying methodologies, different countries and therefore different systems. 

Age of some of the papers and therefore relevance to current systems

Our Take Home

Well done systematic review, but unfortunately unlikely to be of utility given the current state of healthcare (in the UK at least); would be useful in a system with capacity and ability to “flex” to meet demand. 

Online Learning

As discussed at the end of the podcast: 

Phantom abdominal wall extravasation of contrast media on abdominal X-ray | Emergency Medicine Journal (bmj.com)

2 Comments

  1. Dr Chandika Amarasiri Gunawardena says:

    useful study to improve understanding of the subject

  2. Ashraf Ali says:

    useful study of triaging

Leave a Reply