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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
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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.

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.

Related Experiment Videos

  • 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.