Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system.

OBJECTIVE: An ideal emergency department (ED) triage system accurately prioritises patients on the basis of the urgency of interventions required to avoid under- or over-triage. The objective of this study was to develop and validate a five-level Taiwan triage and acuity scale (TTAS) with an electronic decision support tool. METHODS: This prospective, multicentre, observational study included 10533 patients triaged at 11 academic medical centres, 18 regional and four district hospitals. Adult patients presenting to the ED were independently triaged by the duty triage nurse in the usual way and trained research nurses using TTAS with a computerised decision support system. Weighted κ statistics were used to assess the reproducibility. Hospitalisation, length of stay, and medical resource consumption were analysed by TTAS acuity levels. RESULTS: Most cases were stratified into levels 2 to 3 by the existing four-level triage system, whereas the TTAS stratified most patients to levels 3 (41.4%) and 4 (25.0%), and only a small number to level 1 (3.9%) (resuscitation; most urgent). Weighted κ for TTAS assignment was 0.87 (95% CI 0.85 to 0.89). The decrease in mean medical resource consumption and hospitalisation rate was statistically significant with each decrease in the TTAS triage acuity level. The length of stay also decreased significantly as the TTAS level acuity fell from levels 2 to 5. CONCLUSIONS: The TTAS was found to be a reliable triage system that accurately prioritises the treatment needed to avoid overtriage, more efficiently deploying the appropriate resources to ED patients.

Developing and evaluating a wireless speech-and-touch-based interface for intelligent comprehensive triage support systems.

Continuous speech recognition (CSR) technology appears promising in mobile nursing but is not yet well studied. We developed and evaluated bimodal CSR and touchscreen triage support systems in the Emergency department (ED) of a medical center with 2700 beds in 2004-5. Evaluation results show that the average accuracy rates of systems ranged from 94 to 98%. Results suggest that the ED nurses were significantly more willing to use CSR combined with touchscreen systems than the others, such as PDA and CSR alone. A more flexible interface, not efficiency, might be the main reason for this finding.

The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems.

Development and pilot evaluation of user acceptance of advanced mass-gathering emergency medical services PDA support systems.

The support systems for the Emergency Medical Services (EMS) in the mass gatherings, such as the local marathon or the large international baseball games, had been underdeveloped. The purposes for this study were to develop triage-based EMS Personal Digital Assistant (PDA) support systems for the mass-gatherings and to evaluate users' perceived ease of use and usefulness of the systems in terms of Davis' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms-the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. 23 nurses and 6 physicians in the medical center, who had ever served in the mass gatherings, were invited to examine the new systems and answered the TAM questionnaire. The results showed that the PDA systems included as many 450 information items inside 42 screens under 6 categories and the great potential of using triage-based PDA systems in the mass gatherings. Overall, most of the subjects agreed with that the systems were easy to use and useful for the mass gatherings, and they were willing to accept the systems.

Developing a wireless speech- and touch-based intelligent comprehensive triage support system.

The implementation of voice recognition technology has been expected to occur in mobile healthcare settings, but it is the least studied solution in nursing. The objective of this study is to examine its value to mobile nursing. The study was done at a triage station in an emergency department. The system was developed using VB6.0, Microsoft Speech SDK 5.1 and the Simplified Chinese Language pack, and was installed on touchscreen PCs with wireless headsets. Thirty nurses were enrolled. Accuracy rate and operation time were used to measure the subjects' performance. A "willingness to use" score on a scale of 1 to 10 was used to measure subjects' preference for the system. The results showed that the average accuracy rate was 99%, the average operation time was 108 seconds, and the mean "willingness to use" rating was 8.2. This study demonstrates the value of multimodal voice recognition techniques to mobile nursing.

ICU nurses' knowledge of, and attitudes towards, the APACHE II scoring system.

AIMS AND OBJECTIVES: This study was undertaken to determine whether intensive care unit nurses possess adequate knowledge to implement the Acute Physiological and Chronic Health Evaluation (APACHE) II scoring system and to understand nurses' attitudes towards this scoring system. DESIGN: A questionnaire, which contained 20 multiple-choice questions to test knowledge of the scoring system and 27 statements with a five-points Likert type scale to assess attitude, was developed by researchers for this study. METHODS: The participants consisted of 102 intensive care unit nurses working in adult, emergency, or coronary intensive care units in a large teaching hospital (Veterans General Hospital) in Taiwan, where the APACHE II scoring system is used routinely by nurses. RESULTS: On the knowledge section of the questionnaire, 76% of the questions were answered correctly. However, more than 50% of the nurses were uncertain about how to score a patient's chronic history status, only 44.1% of the nurses knew that APACHE II total scores range from 0 to 71, and only 37.3% understood that the value for bicarbonate in venous samples could replace the arterial pH value. The results of the attitude questionnaire revealed that nurses believed APACHE II was useful mainly for statistical purposes by the administration rather than for patient care, but acknowledged that the scores could provide a reference for more aggressive treatment. CONCLUSIONS: The questionnaire answers indicated that greater knowledge concerning the APACHE II is needed. RELEVANCE TO CLINICAL PRACTICE: Information and training concerning the proper use and purpose of APACHE II needs to be provided, especially for those intensive care unit nurses using this evaluation tool to score patients' conditions routinely.