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Related Experiment Videos

Does a physician visual assessment change triage?

J C Brillman1, D Doezema, D Tandberg

  • 1Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131-5246, USA.

The American Journal of Emergency Medicine
|January 1, 1997
PubMed
Summary

Physician visual assessment of emergency patients reduced agreement with nurse triage but improved the ability to predict hospital admission. This impacts emergency department patient assessment strategies.

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Area of Science:

  • Emergency Medicine
  • Clinical Triage Research
  • Healthcare Quality Improvement

Background:

  • Accurate emergency department (ED) triage is crucial for patient outcomes.
  • Physician involvement in triage may enhance accuracy but requires investigation.
  • Current triage relies heavily on nurse assessment, with variable physician input.

Purpose of the Study:

  • To evaluate the impact of physician visual assessment on emergency patient triage categorization.
  • To determine if physician visual assessment improves the prediction of hospital admission.
  • To compare interobserver agreement between nurses and physicians with and without visual assessment.

Main Methods:

  • Prospective comparative trial involving 3,949 consecutive ED patients.

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  • Triage categorization by registered nurses (RNs) and emergency physicians (EPs).
  • EPs had the option to perform a visual assessment; data analyzed using Kappa and MacNemar's tests.

    • Main Results:

    • Physicians visually assessing patients triaged them as sicker (P < .001).
    • Interobserver agreement decreased significantly when EPs performed visual assessments (Kappa .21 vs .45).
    • Physician visual assessment improved sensitivity for predicting admission (69.3% vs 54.9%) with a slight decrease in specificity (83.9% vs 88.5%).

    Conclusions:

    • Physician visual assessment in triage decreases agreement with nurse categorization.
    • Visual assessment by physicians enhances the prediction of hospital admission, despite reduced interobserver agreement.
    • Findings suggest a trade-off between agreement and predictive accuracy in ED triage.