Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system's validity.

OBJECTIVE: Roughly 5% to 10% of patients admitted to the emergency department suffer from acute abdominal pain. Triage plays a key role in patient stratification, identifying patients who need prompt treatment versus those who can safely wait. In this regard, the aim of this study was to estimate the performance of the Manchester Triage System in classifying patients with acute abdominal pain. METHODS: A total of 9,851 patients admitted at the Emergency Department of the Merano Hospital with acute abdominal pain were retrospectively enrolled between 1 January 2017 and 30 June 2019. The study was conducted and reported according to the STROBE statement. The sensitivity and specificity of the Manchester Triage System were estimated by verifying the triage classification received by the patients and their survival at seven days or the need for acute surgery within 72 h after emergency department access. RESULTS: Among the patients with acute abdominal pain (median age 50 years), 0.4% died within seven days and 8.9% required surgery within 72 hours. The sensitivity was 44.7% (29.9-61.5), specificity was 95.4% (94.9-95.8), and negative predictive value was 99.7% (99.2-100) in relation to death at seven days. CONCLUSIONS: The Manchester Triage System shows good specificity and negative predictive value. However, its sensitivity was low due to the amount of incorrect triage prediction in patients with high-priority codes (red/orange), suggesting overtriage in relation to seven-day mortality. This may be a protective measure for the patient. In contrast, the need for acute surgery within 72 h was affected by under-triage. RELEVANCE TO CLINICAL PRACTICE: The triage nurse using Manchester Triage System can correctly prioritise the majority of patients with acute abdominal pain, especially in low acuity patients. The Manchester Triage System is safe and does not underestimate the severity of the patients.

[From bedside to evidence - and back to bedside. 5 years evidence-based guidelines in South Tyrol: methods and experiences]. / Vom Bett zur Evidenz - und wieder zurück. 5 Jahre evidenzbasierte Leitlinien in Südtirol: Vorgehen und Erfahrungen.

In South Tyrol we developed guidelines with two different methodological approaches: one relates to the autonomous development of a nursing guideline for oral care using GRADE, and the other relates to the adaptation process of the NICE guideline on the prevention of venous thromboembolism. Both methods do have advantages and disadvantages: by autonomously developing guidelines the guideline panel identifies more with the product but time and effort is much higher than adapting and amending existing (high quality) guidelines. On the other hand there are only few high quality nursing guidelines. Additionally, the experiences in South Tyrol show that nursing guidelines seem to be not really suitable for a 1:1 application into practice because nearly half of the nurses have not changed their practice - although they knew the content of the guideline. Therefore, in order to promote the implementation process multimodal strategies on different organisational levels were adopted. Amongst these was the involvement of management through the negotiations of objectives, training and active participation of staff in the development of user-friendly application tools.

[Measuring nurses' attitudes to family care: a longitudinal mixed method study]. / Misurare l'atteggiamento degli infermieri nel prendersi cura della famiglia: uno studio mixed method longitudinale.

. Measuring nurses' attitudes to family care: a longitudinal mixed method study. INTRODUCTION: In a scenario of demographic changes with an ageing population and an increase in people with chronic illnesses, the family assumes a central role in the care of their family member. Providing nurses with knowledge and strategies of family-centred care may change current standards of practice to a more family-focused approach. OBJECTIVES: To explore nurses' perceptions on the importance of involving families in the project of care and their attitudes before, during and after an implementation of family-centred care. METHODS: A longitudinal mixed method study was conducted during the implementation of family-centred care in a health district. A training package for the district nurses and individual coaching by an experienced nurse were offered. The Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) questionnaire was administered pre- and post training and one year later and two focus groups were conducted. RESULTS: All the 19 health district nurses participated in the study; average age 49.3 years, working experience 26.8 years. Statistically significant changes were observed in all four dimensions of the FINC-NA: family as a personal and professional resource, as a partner and a burden. The same results were confirmed by the focus groups. CONCLUSIONS: An educational intervention for home care nurses proved to be useful during the implementation of family-centred care. A key aspect was the support offered to nurses in transferring their knowledge and skills to their practice.

[The implementation of family nursing in a municipality of the Provence of Bolzano]. / L'esperienza dell'introduzione dell'infermiere di famigliain un comune della Provincia di Bolzano.

. The implementation of Family Nursing in a municipality of the Provence of Bolzano. In the Province of Bolzano, 45 Family and Community Nurses have been trained to date with a 1250-hour course of which 400 hours of practical training. The working model adopted is the Calgary Assessment model, based on ithe relationship with families. The experience of the District of Bassa Atesina, which includes ten municipalities and about 40,000 inhabitants, is described, and in particular the assignment of three family nurses to a mountain municipality with a population of 1700 inhabitants, located with a considerable territorial dispersion. The FCNs cared for 48 families with tailored care plans. The model will be extended to other Districts.

Errors in nurse-led triage: An observational study.

BACKGROUND: Nurses play a crucial role in correctly prioritizing patients entering emergency departments. However, little is known of the accuracy of nurse-led triage systems. OBJECTIVES: (1) To determine the frequency of nurse-led triage errors within the Manchester Triage System; (2) to explore patient, work environment and individual nurse factors associated with triage errors; and (3) to explore associations between triage errors and patient outcomes (i.e., length of emergency department stay, hospitalization, and 7- and 30-day mortality). SETTING: This study was conducted in one emergency department in Northern Italy. PARTICIPANTS: A random sample of 5% (n = 1,929) of all eligible patients accessing the emergency department over an 18-month period. METHODS: For this retrospective observational study, electronic health record data on triage errors (i.e., incorrect presentational flowchart, specific discriminator and/or priority level) and triage nurses were combined with routine data on patient characteristics, outcomes and the work environment. To explore relationships between these variables, we performed univariate and multivariate logistic regression analyses. RESULTS: We observed triage errors in 16.3% of patients (n = 314). These were significantly associated with patients' emergency department and hospital stays. Analyses revealed that when > one patient was triaged every 15 min (OR: 2.112;95%CI: 1.331-3.354), older patients (OR: 1.009; 95%CI: 1.003-1.015) with > than two chronic conditions (OR: 1.506; 95%CI: 1.091-2.081) and orange or red priority codes (OR: 1.314; 95%CI: 1.046-1.651,) whose triage nurse had previous experience with another triage system (OR: 3.189; 95%CI: 2.455-4.14) had higher odds of triage errors. CONCLUSION: We provided primary evidence on triage errors. Confirming our findings on the prevalence, nature and consequences of such errors will require further prospective multicenter studies. Considering patient factors (e.g., age, polychronicity) as additional discriminators could make the nurse-led triage process using the Manchester Triage System more accurate. Investigating the roles of triage nurses' training and background and the emergency department work environment on their mental models regarding the triage process will require qualitative research.

Performance of the Manchester Triage System in patients with dyspnoea: A retrospective observational study.

BACKGROUND: Between 1% and 7.5% of patients admitted to the emergency department (ED) suffer from dyspnoea. The Manchester Triage System is one of Europe's most used triage systems considering five levels to prioritize patients in the ED: level 1 (red), immediate; level 2 (orange), very urgent; level 3 (yellow), urgent; level 4 (green), standard; level 5 (blue), non-urgent. With this study we aimed to evaluate the performance of the Manchester Triage System in patients with dyspnoea. METHODS: With this retrospective, observational study we analysed data from 4'076 patients with dyspnoea accessing the ED in one Italian hospital between January 1, 2017 and June 30, 2019. To determine the sensitivity and specificity we computed the area under the curve (AUC) of the receiver operating characteristics (ROC) comparing the sensitivity and specificity for each of the five priority codes and seven-day mortality. RESULTS: A total of 3.6% (n = 145) of the patients died within seven days after access to the ED. From the patients dying within seven days, 6.2% (9/145) had a blue or green priority code, 17.9% (26/145) had a yellow priority code and 75.9% had an orange or red priority code. A high priority code (orange or red) had a sensitivity of 75.9%, a specificity of 66.1%, a PPV of 7.6% and a NPV of 98.7%. The AUC was 0.734 (CI 95% 0.695-0.773, p < 0.001). CONCLUSIONS: The Manchester Triage System showed acceptable sensitivity and negative predictive value in patients with dyspnoea, yet a low specificity related to the risk of death. The system is safe, resulting in a low under-triage rate for death. Improving the clinical assessment during nurses' triage (e.g. considering clinical history and auscultation of lungs) and prospective validation studies with surrogate endpoints is needed in this population.

Living on the Own Island? Aligned Collaboration Between Family Physicians, Nurses, Dieticians, and Patients With Diabetes Type 2 in an Outpatient Care Setting in Northern Italy: Findings From a Qualitative Study.

INTRODUCTION: Diabetes mellitus type 2 (DM2), one of the four most important chronic diseases worldwide, is generally considered to be preventable. However, it is not yet sufficiently clear whether an aligned collaboration between different health professions could facilitate behavioral changes to be made by patients with DM2 regarding their eating and physical activity habits. OBJECTIVE: To explore if and how far in current outpatient care for 3 health-care professions it is an objective to collaborate with each other supporting patients with DM2 in changing their eating and physical activity habits. METHODS: We conducted 18 qualitative problem centered interviews with selected family physicians, nurses, dieticians working in outpatient setting and patients with DM2, transcribed verbatim, and analyzed with qualitative content analysis. RESULTS: Issues identified ranged from description and reflection of current health-care practice, strategies, and hindrances to cope with changes of eating and physical activity behaviors as well as for health-care practice regarding interprofessional collaboration and patient-centered care up to considerations about collaboration and patient centricity (for health professionals and patients to achieve goals) and changes and ideas of "ideal care practice". DISCUSSION: The included professional groups work predominantly for themselves. Collaboration currently only takes place when individually triggered and neither structured nor organized.

Triage of patients with fever: The Manchester triage system's predictive validity for sepsis or septic shock and seven-day mortality.

OBJECTIVE: Up to 15% of patients arrive in the emergency department suffering from fever. Triage is their first contact and is responsible for the stratification of patients according to the severity of the condition for which they are presenting at the emergency department. The aim of this study is to assess the predictive validity of the Manchester Triage System in patients with fever for sepsis or septic shock and seven-day mortality. METHODS: The sensitivity, specificity and negative predictive value of the Manchester Triage System was assessed by priority code allocation towards seven-day mortality and the diagnosis of sepsis or septic shock. RESULTS: A total of 3831 patients were evaluated in the emergency department for fever between 1 January 2017 and 30 June 2019. Of these, 1.9% were diagnosed with sepsis or septic shock. Using the Manchester Triage System to predict diagnosis of sepsis or septic shock provided a sensitivity of 88.7%, a specificity of 50.1% and a negative predictive value of 99.5%. For seven-day mortality, sensitivity was 44.4%, specificity was 92.3% and the negative predictive value was 99.3%. CONCLUSION: The Manchester Triage System has demonstrated high sensitivity and negative predictive value in patients with fever diagnosed with sepsis or septic shock. For patients with sepsis or septic shock one-third of cases with an incorrectly assigned priority code were caused by incorrect application of the Manchester Triage System.

Building a subset of ICNP terms for oncological patients.

The present project was undertaken applying ICNP to internistic-oncological patients. This project investigated the coverage of this patient group by mapping terminology used in practice with ICNP. The specific aim was to build a subset of ICNP terms for oncological patients that can be used as a basic data catalogue for computerised nursing documentation. Furthermore the mappings, quality of match, and experiences of mapping was evaluated to discuss the domain completeness and utility of the ICNP in depicting the typical situation of oncological patients. The finding of this study will be submitted to the ICNP Review Process. The results can contribute to extending the ICNP content. The new ICNP statements will provide a beginning of an ICNP catalogue for cancer care.