Effectiveness of the Manchester Triage System on time to treatment in the emergency department: a systematic review.

OBJECTIVE: The objective of this review was to synthesize the best available evidence on the effectiveness of the Manchester Triage System (MTS) on time to treatment (TtT) for patients who visit the emergency department (ED). INTRODUCTION: The objectives of the MTS are to define a safe wait time for medical attention. Triage systems, such as the MTS, use criteria to ensure patient safety by determining appropriate wait times for each individual who visits the ED. The TtT is the time interval between arrival at the ED to initiation of therapeutic interventions. A short TtT is important in different clinical situations and may reduce infections and mortality. The MTS may have an impact on the TtT. INCLUSION CRITERIA: This review considered studies that included any patients visiting the ED with any complaints or medical diagnoses who were triaged using the MTS by nurses or doctors, and the TtT was measured. This review considered randomized controlled trials, as well as quasi-experimental, before-and-after, case-control and analytical cross-sectional studies. Studies published after 1994 in English, Spanish, Portuguese, French and German were considered for inclusion. METHOD: This systematic review was conducted in accordance with JBI methodology. The search strategy aimed to find both published and unpublished studies in MEDLINE, CINAHL, Lilacs, Web of Science, Embase, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Banco de Teses - CAPES, and Digital Dissertations. The results of this search were assessed by one reviewer who excluded duplicate results. Titles and abstracts were screened by two independent reviewers for assessment against the inclusion criteria. The full texts of potentially eligible papers were retrieved and independently assessed by two reviewers using a standardized critical appraisal instrument from JBI. Data were extracted from studies included in the review and were presented using a narrative form. Tables were used to summarize the characteristics and findings of the studies. RESULTS: The review included two before-and-after studies, with a total of 2265 participants. One study was of moderate quality, and the other was of high quality. One study included only patients with acute ischemic stroke, while the other included patients with any complaint. Both studies were performed with consecutive samples. The median TtT was 10 minutes before implementing the MTS and 12 minutes after implementing the MTS in the study that included patients with any complaints. In the study including patients with acute ischemic stroke, the median TtT decreased by 15 minutes after implementing the MTS (from 75 to 60 minutes). Because of the heterogeneity in the characteristics of the populations of the two studies, the results could not be pooled. CONCLUSIONS: The MTS reduced the median TtT for patients triaged at the highest priority levels (orange and yellow), but it did not decrease the median TtT in all patients. The existing evidence base regarding the effectiveness of the MTS comes from two studies with methodological limitations that could not be pooled. The evidence indicates the MTS may confer benefit to some patients who visit the ED by reducing TtT, but not for all patients. Further research is needed before firm conclusions can be made.

Electronic and manual registration of Manchester System: reliability, accuracy, and time evaluation.

OBJECTIVE: to evaluate the degree of reliability, accuracy and timing to perform the Manchester Triage System in electronic and manual records. METHOD: exploratory-descriptive research. Case series corresponded to a total of 20 validated simulated clinical cases applied to a sample of 10 nurses. For data collection each participant received 4 clinical cases in 2 different phases of the study, using manual and electronic registration. The variables related to the triage were: incomplete data filling, discriminator, flowchart, priority level, vital signs and triage timing. RESULTS: moderate reliability for choosing flowcharts and substantial reliability for determining discriminators in both records; substantial and moderate, for priority, respectively, in manual and electronic registration. For vital signs, it was weak in manual recording and substantial in electronic. Accuracy showed a statistically significant difference related to vital signs. The average timing on triage was shorter with the use of electronic registration. CONCLUSION: the use of electronic registration has advantages regarding reliability, accuracy and timing to perform the triage, pointing to the importance of adopting technologies in the management and care work process in health services.

Avaliação do sistema Manchester de classificação de risco com o uso de registro eletrônico e manual / Evaluation of the Manchester Triage System with the use of electronic and manual registration

Introdução: O Sistema Manchester de Classificação de Risco (SMCR) estabelece um tempo para o atendimento médico conforme o grau de urgência dos pacientes, a partir de um processo de tomada de decisão por registro eletrônico ou manual. Objetivo: Avaliar o grau de confiabilidade, a acurácia e o tempo despendido para a realização do SMCR em registros eletrônico e manual. Método: Estudo exploratório-descritivo de abordagem quantitativa, realizado com todos 43 (100%) enfermeiros do Hospital Universitário da Universidade de São Paulo (HU-USP) que foram aprovados no curso de classificador do SMCR pelo Grupo Brasileiro de Classificação de Risco (GBCR). A casuística do estudo correspondeu ao número total de casos clínicos simulados (37) validados e fornecidos pelo GBCR e ao número de casos aplicados para cada participante da pesquisa (4). A amostra foi estimada, para que se obtivesse um coeficiente kappa de Cohen maior ou igual a 0,5, confiança de 95% e poder de teste de 80%, considerando o número de pacientes classificados em cada nível de prioridade clínica no HU-USP em 2016. A amostra foi composta por 10 participantes. A coleta de dados foi realizada, em duas fases, utilizando 20 casos clínicos simulados, os quais passaram por processo de avaliação junto a especialistas do GBCR. Na fase 1, foram entregues 4 casos para uso no registro manual e na fase 2, após aproximadamente, 4 semanas, os mesmos casos foram entregues para realização do SMCR por meio do registro eletrônico. A confiabilidade inter-avaliadores foi calculada pelo coeficiente kappa de Cohen e, em relação ao padrão ouro (acurácia), pela porcentagem de concordância. O tempo despendido foi analisado com o teste Wilcoxon-Mann-Whitney, considerando intervalo de confiança de 95% e valor de p menor que 0,05. Resultados: O grau de confiabilidade foi igual para a escolha dos fluxogramas e dos discriminadores com o uso de ambos os registros e apresentou diferenças na determinação da prioridade e dos sinais vitais. A acurácia apresentou diferença estatisticamente significante, apenas, em relação aos sinais vitais. O tempo despendido para o registro do SMCR foi menor com o uso eletrônico. Conclusão: O uso do registro eletrônico apresenta vantagens referentes à confiabilidade, acurácia e tempo despendido para a realização da classificação de risco, indicando a importância da adoção de tecnologias no processo de trabalho gerencial e assistencial nos serviços de saúde.

Introduction: The Manchester Triage System (MTS) defines clinical priority by determining the maximum allowed waiting time for medical care for the different levels of urgency based on decision support process by electronic or manual registration. Objective: Evaluate the degree of reliability, accuracy and time spent of the use of MTS with an electronic or manual registration. Method: This is an exploratory-descriptive study applied for all (43) nurses of the University Hospital of the University of São Paulo (HU-USP) approved in the MTS classifier course by Brazilian Group of Risk Classification. The casuistry of the study corresponded to the total number of simulated clinical cases (37) and the number of cases applied to each participant (4). The sample were calculated to obtain a Cohen kappa coefficient equal to 0.5 or greater than it, 95% confidence and 80% test power, considering the number of patients classified in each clinical priority level at the HU-USP in 2016. The sample had 10 participants. Data were collected from the triage of 20 clinical cases. This clinical cases were evaluated by Brazilian Group experts. In phase 1, 4 cases were given for use in the manual registration. In phase 2, after approximately 4 weeks, the same cases were given for use in the electronic registration. The inter-rater reliability was calculated by the Cohen kappa coefficient. The accuracy (the comparison with the golden standard) was calculated by the concordance percentage. The efficiency was calculated by the Wilcoxon-Mann-Whitney test, with a 95% confidence interval and p-value less than 0.05. Results: The degree of reliability was the same for the choice of flowcharts and discriminators with the use of electronic and manual registration. There were differences in reliability for determination of priority and the recording of vital signs. The accuracy presented a statistically significant difference only in relation to vital signs. The time spent with use the MTS was shorter with electronic registration. Conclusion: The use of the electronic registration had advantages related to the reliability, accuracy and time spent to use the MTS, showing how important it is to adopt technologies in the manage and assistencial care working process of the health services.

[Organ donation and transplantation: Brazilian nursing publications]. / Doação e transplante de órgãos: produção científica da enfermagem brasileira.

The objectives of this bibliographic study were to identify and to characterize nursing scientific productions of organ donation and transplantation since 1997 to 2007. The LILACS, MEDLINE, BDENF, PERIENF AND DEDALUS databases were searched using the following keywords: "nursing and transplantation" and "nursing and donation", identifying 30 articles. The results had shown that the most of publications from the southeast region; the majority of approaching was qualitative; nurses were the main authors and the principal subjects were renal and hepatic transplantation. It was concluded that it is necessary more Brazilian nursing publications of organ donation and transplantation.

Doação e transplante de órgãos: produção científica da enfermagem brasileira: [revisão] / Donación y transplante de órganos: producción científica de la enfermería brasileña: [revisión] / Organ donation and transplantation: Brazilian nursing publications: [review]

Estudo bibliográfico cujos objetivos foram identificar e caracterizar as produções científicas de enfermagem em doação e transplante de órgãos, no período de 1997 a 2007. Realizou-se busca das publicações nacionais nas bases de dados LILACS, MEDLINE, BDENF, PERIENF E DEDALUS, com as palavras-chave: "enfermagem e transplante" e "enfermagem e doação". Os 30 artigos encontrados foram analisados sob diversos aspectos, obtendo-se como resultados principais: a maioria originou-se do Sudeste, teve abordagem qualitativa, foi da autoria de enfermeiros assistenciais e abordou o tema transplante, especialmente renal e hepático. Conclui-se que se faz necessário um maior número de estudos científicos, desenvolvidos pela enfermagem de todo o país, sobre os diversos aspectos da doação e transplante de órgãos.

The objectives of this bibliographic study were to identify and to characterize nursing scientific productions of organ donation and transplantation since 1997 to 2007. The LILACS, MEDLINE, BDENF, PERIENF AND DEDALUS databases were searched using the following keywords: "nursing and transplantation" and "nursing and donation", identifying 30 articles. The results had shown that the most of publications from the southeast region; the majority of approaching was qualitative; nurses were the main authors and the principal subjects were renal and hepatic transplantation. It was concluded that it is necessary more Brazilian nursing publications of organ donation and transplantation.

Estudio bibliográfico cuyos objetivos fueron identificar y caracterizar las producciones científicas de enfermería sobre donación y trasplante de órganos, en el período de 1997 a 2007. Se buscaron publicaciones en las bases de datos LILACS, MEDLINE, BDENF, PERIENF Y DEDALUS, con las palabras clave: "enfermería y trasplante" y "enfermería y donación", identificándose 30 artículos. Los resultados encontrados mostraron que los trabajos se originaron principalmente en el Sudeste, el enfoque cualitativo fue el más utilizado, los enfermeros fueron los autores principales y los temas utilizados con más frecuencia fueron el trasplante renal y el hepático. Se concluye que es necesario más publicaciones de enfermería brasileña sobre donación y trasplante de órganos.