Impacts of the introduction of a triage system in Japan: a time series study.

The aim of the present study was to measure and compare the effectiveness of nursing triage before and after introduction of the Japanese Triage and Acuity Scale (JTAS), the Japanese version of the Canadian Triage and Acuity Scale (CTAS), during emergency treatment. Surveys of triage nurses and emergency physicians were conducted before and after JTAS introduction. Respondents were triage nurses (before 112 cases, after 94 cases), emergency physicians (before 50, after 41), and triaged patients (before 1057, after 1025) from seven separate emergency medical facilities. The results showed that nursing triage using the JTAS shortened "time from registration to triage" by 3.8min, "triage duration" by 1min, "time from registration to physician" by 11.2min, and "waiting time perceived by patients to see a physician" by 18.6min (p<0.001). The difference in assigned level of urgency between triage nurses and emergency physicians decreased from 34.2% to 12.2% (p<0.001), over-triage decreased from 24.7% to 8.6% (p<0.001), and under-triage decreased from 9.5% to 3.6% (p<0.001). Furthermore, assessment agreement between triage nurses and emergency physicians increased significantly, from weighted κ=0.486 to weighted κ=0.820. These findings suggest that the introduction of the JTAS promoted more effective nursing triage and medical care.

Grief reaction model of families who experienced acute bereavement in Japan.

The present study clarified the structure of factors that affect grief reactions of families who experienced acute bereavement in critical care settings in Japan. Sixty-four families who experienced acute bereavement answered a questionnaire. The questionnaire included the Miyabayashi Grief Measurement, recognition of bereavement, Multidimensional Scale of Perceived Social Support, and the Tri-Axial Coping Scale. We analyzed the causal structure regarding the relationship of stress recognition, coping, and grief reactions using structural equation modeling. The greatest influence on grief reactions of bereaved families was stress recognition. Factors that influenced stress recognition were subjective degree of sadness, acceptance of bereavement, regret for bereavement, and recognition of a peaceful death. These results show that the quality of end-of-life care in critical care settings is an important factor that affects bereaved families' stress recognition and grief reactions. Nurses and medical staff must provide end-of-life care to help family members accept the death of their loved one and reduce regrets as much as possible.