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Vol. 8 No. 1 (2020): Jurnal Keperawatan Padjadjaran

Comparison of Four-Level Modification Triage with Five Level Emergency Severity Index (ESI) Triage Based on Level of Accuracy and Time Triase

July 6, 2019


The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.

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  1. Ardiyani, V.M. (2015). Analisis peran perawat triage terhadap waiting time dan length of stay pada ruang triage di instalasi gawat darurat Rumah Sakit Dr. Saiful Anwar Malang. (Analysis of the role of triage nurses on waiting time and length of stay in the triage room in the emergency department of Dr Saiful Anwar Hospital, Malang). Care: Jurnal Ilmiah Ilmu Kesehatan, 3(1), 39–50.
  2. Bukhari, H., Albazli, K., Almaslmani, S., Attiah, A., Bukhary, E., Najjar, F., ..., & Al-Maghrabi, H. (2014). Analysis of waiting time in emergency department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Open Journal of Emergency Medicine, 2(04), 67.
  3. Christ, M., Grossmann, F., Winter, D., Bingisser, R., & Platz, E. (2010). Triage in der Notaufnahme. Dtsch Arztebl International, 107(50), 892-898.–898. 10.3238/arztebl.2010.0892
  4. Considine, J., Ung, L., & Thomas, S. (2001). Clinical decisions using the national triage scale: How important postgraduate education?. Accident and emergency nursing, 9, 101–108.
  5. Dadashzadeh, A., Abdolahzadeh, F., Rahmani, A., & Ghojazadeh, M. (2013). Factors affecting triage decision-making from the viewpoints of emergency department staff in Tabriz Hospitals. Iran Journal Critical Care Nurs, 6(4), 269–276.
  6. Dahlan, M.S. (2013). Besar sampel dan cara pengambilan sampel dalam penelitian kedokteran dan kesehatan (3rd ed). Salemba Medika.
  7. Departemen Kesehatan RI. (2011). Standar pelayanan keperawatan gawat darurat di rumah sakit. (Standards for emergency nursing services in hospitals). Jakarta.
  8. Ekins, K., & Morphet, J. (2015). The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia country health service region. Australasian Emergency Nursing Journal, 18(4), 227–233.
  9. Elshove-Bolk, J., Mencl, F., van Rijswijck, B.T., Simons, M.P., & van Vugt, A.B. (2007). Validation of the emergency severity index (ESI) in self-referred patients in a European emergency department. Emergency Medicine Journal, 24(3), 170–174.
  10. FitzGerald, G., Jelinek, G.A., Scott, D., & Gerdtz, M.F. (2009). Emergency department triage revisited. Emerg Med J., 27, 85–92.
  11. Gilboy N., Tanabe T., Travers, D.A., & Rosenau, A.M. (2011). Emergency severity index (ESI): A triage tool for emergency department care, version 4. Implementation handbook (2012 edition). AHRQ Publication No. 12-0014. Rockville, MD. Agency for Healthcare Research and Quality.
  12. Golzari, S.E., Soleimanpour, H., Raoufi, P., Salarilak, S., Sabahi, M., Nouri, H., & Heshmat, Y. (2014). Accuracy of emergency severity index, version 4 in emergency room patients’ classification. Journal Analytic Respiratory Clinical Medic, 2(1), 39–44.
  13. Hinson, J.S., Martinez, D.A., Schmitz, P.S., Toerper, M., Radu, D., Scheulen, J., ..., & Levin, S. (2018). Accuracy of emergency department triage using the emergency severity index and independent predictors of under-triage and over-triage in Brazil: A retrospective cohort analysis. International journal of emergency medicine, 11(1), 3.
  14. Khankeh, H.R., Zavareh, D.K., Naghdloo, F.A., Hoseini, M.A., & Rahgozar, M. (2007). Effect of triage on medical services waiting time and patient satisfaction in shahid rajae hospital emergency depart¬ment in Karaj Tehran: University of social welfare and rehabilitation. Iran Journal Nursing Midwifer., 18(1), 79–83.
  15. Levsky, M.E., Young, S.E., Masullo, L.N., Miller, M.A., & Herold T.J. (2008). The effect of an accelerated triage and treatment protocol on left witout being seen rates and wait times of urgetn patients at a military emergency departement. Military medicine, 173(10), 999–1003.
  16. Mace, S.E., & Mayer, T.A. (2013). Triage. The Practice Environment.
  17. Nurmansyah, E., Susilaningsih, F.S., & Setiawan. (2014). Tingkat ketergantungan dan lama perawatan pasien rawat observasi di IGD. (The level of dependence and length of stay of observational patients in the ED). Jurnal Keperawatan Padjadjaran, 2(3), 191–201.
  18. Ramdan, I.M., & Rahman, A. (2017). Analisis resiko kesehatan dan keselamatan kerja pada perawat. (Health and safety risk analysis for nurses). Jurnal Keperawatan Padjadjaran, 5(3), 229–241.
  19. RSUD Cibabat Cimahi. (2015). Laporan akuntabilitas kinerja pemerintah TA 2015 RSUD Cibabat Cimahi. (Government Performance Accountability Report FY 2015 Cibabat Cimahi Hospital). RSUD Cibabat Cimahi.
  20. Safdar, A., Susilaningsih, F.S., & Kurniawan, T. (2019). Relationship between workload performance and job satisfaction. Jurnal Keperawatan Padjadjaran, 7(3), 222–229.
  21. Smith, A., & Cone, K.J. (2010). Triage decision making. Journal For Nurse in Staff Development, 26(1), E14–19.
  22. Villa, S., Weber, E.J., Polevoi, S., Fee, C., Maruoka, A., & Quon, T. (2018). Decreasing triage time: Effects of implementing a step-wise ESI algorithm in an EHR. International Journal for Quality in Health Care, 30(5), 375–381.