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Pediatric nurse triage. Its efficacy, safety, and implications for care
Insights
Pediatric nurse triage effectively directs most walk-in children to external care, ensuring safety and reinforcing community health centers for primary care needs.
Area of Science:
- Pediatric emergency medicine
- Healthcare management
- Triage protocols
Background:
- Urban children's hospitals often refer patients externally for care.
- Evaluating the effectiveness of emergency room (ER) triage is crucial for resource allocation and patient outcomes.
Purpose of the Study:
- To assess the safety and efficacy of nurse-led triage for pediatric walk-in patients.
- To determine patient referral patterns and appointment adherence following triage.
- To compare outcomes for patients treated within the ER versus those referred externally.
Main Methods:
- A six-week study involving 748 pediatric patients (1 week to 17 years) at a large urban children's hospital.
- Tracking patient referral destinations (community health centers, private physicians, home, ER) and appointment keeping rates.
- Comparing physician diagnoses with triage nurse assessments and evaluating patient recovery at two weeks post-triage.
Main Results:
- 61% of pediatric patients were referred outside the hospital; 9% were treated in the ER.
- Patients referred externally had lower appointment-keeping rates (62%) compared to those seen in the ER/hospital clinics (97%).
- Same-day appointments had the highest adherence (81%), and nurse diagnoses were accurate or less severe than physician diagnoses in 93.4% of cases.
Conclusions:
- Nurse triage for pediatric walk-in patients is a safe and effective alternative to traditional ER care.
- The system successfully directs patients to appropriate care settings, reinforcing the role of community health centers.
- Timely appointments significantly improve adherence, highlighting the importance of efficient referral processes.
Abstract:
This study evaluates emergency room (ER) triage at a large urban children's hospital, in which patients are routinely referred outside of the institution for care. Seven hundred forty-eight children from 1 week to 17 years of age were enrolled in the study over a six-week period. Nearly two thirds (61%) of the patients were sent outside of the hospital for care; 31% of the patients were sent to community health centers, 17% were sent to private physicians' offices, 13% were sent home (self-care), and only 9% were treated in the ER. Ninety-four percent of appointments--of which 74% were kept--were for care within two days of the triage visit, with patients who were sent to the ER or hospital clinics keeping more appointments than those who were sent outside the hospital for care (97% vs 89% vs 62%). Patients who had an appointment on the same day kept it better than those who waited one to three days, who in turn had a higher rate of appointment-keeping than those who waited more than three days (81% vs 63.4% vs 41.2%). The physician's diagnosis agreed with the triage nurse's diagnosis or was less serious than the nurse's diagnosis in 93.4% of patients. At two weeks after triage, nearly all patients had completely recovered, with no correlation of symptoms with level or site of care. This study indicates that nurse triage of pediatric walk-in patients, in which three of five patients are referred outside of the hospital for care, is a safe and effective alternative to care in the ER and, at the same time, serves to reinforce community health centers as the appropriate setting for primary care.