The new role of triage nurse ordering in emergency department depend on Emergency Severity Index : A randomized control trial

2021 Fiscal Year Final Research Report

• Project/Area Number: 18K17541
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58060:Clinical nursing-related
• Research Institution: Kansai University of Social Welfare
• Principal Investigator: KOICHI TAKAOKA 関西福祉大学, 看護学部, 講師 (70781699)
• Project Period (FY): 2018-04-01 – 2022-03-31
• Keywords: 緊急度判定 / トリアージ / 救命救急センター / Emergency Severity Index / 熟練看護師 / 待機時間 / 臨床判断 / 看護師教育

Outline of Final Research Achievements

The Emergency Severity Index (ESI) is a highly reliable and valid triage scale that is widely used in emergency departments (EDs) in not only English language regions, but also other countries. The Japan Triage and Acuity Scale (JTAS) is frequently used for emergency patients, and the ESI has not been evaluated against the JTAS in Japan. This study aimed to examine the decision accuracy of the ESI for simulated clinical scenarios among nursing specialists in Japan compared with the JTAS. A parallel-group randomized trial was conducted.
Inter-rater agreement for triage decisions was classified into a higher category in ESI than in the JTAS group at level 2. In other words, triage decisions based on the ESI scale in Japan maintain the same level of inter-rater agreement and sensitivity as those in other countries.
These findings suggest that the ESI can be introduced in Japan, despite its different emergency medical background compared with other countries.

Free Research Field

救急看護学

Academic Significance and Societal Importance of the Research Achievements

従来、逼迫する救急患者へ対応するために、医師の診察待機の可否を看護師（トリアージナース）が判断する緊急度判定が注目され、診察待機時間の短縮および救急外来での急変予防に貢献している。本邦ではJTASを筆頭に普及が進んでいるが、未だ全体的な浸透に至っていない。
本研究では、専門性の高いトリアージナースを対象に、JTASと国際的に広く運用されているESIの緊急度判定精度について、模擬患者を対象としたRCTで検証した。
ESIはJTASと比較して、患者の診察待機も判定に最も重要な基準において、高い判定精度を示した。また、諸外国に比して同等の判定精度を担保し、我が国の救急臨床に応用できることが示唆された。