| 1. |
- Olsson, Martin, et al.
(author)
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Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care – A cross-sectional study
- 2022
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 63
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Journal article (peer-reviewed)abstract
- AimTo determine the reliability of application of the RETTS© triage scale after an educational intervention using paper-based scenarios in emergency care education.BackgroundKnowledge about and education in triage are important factors in triagescale implementation. Presenting students with a large number of triage scenarios is a common part of triage education.MethodsIn this prospective cross-sectional study at two universities students undergoing education in emergency care used RETTS© to assess triage level in 46 paper-based scenarios.Results57 students in the study made 2590 final triage decisions. Fleiss Kappa for final triage was 0.411 which is in the lower range of moderate agreement. In 25 of 46 (53.4%) scenarios, final triage levels did not agree about whether the case was stable or unstable.Conclusion/ImplicationsApplication of the RETTS© triage scale after an educational intervention with paper-based simulation in emergency care education resulted in moderate agreement about the final levels of triage.
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| 2. |
- Wireklint, Sara, et al.
(author)
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A descriptive study of registered nurses’ application of the triage scale RETTS© : a Swedish reliability study
- 2018
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 38, s. 21-28
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Journal article (peer-reviewed)abstract
- BackgroundFrom a patient safety perspective, it is of great importance that decision support systems such as triage scales are evidence based. In the most recent national survey, the majority of Swedish Emergency Departments (EDs) apply the Swedish triage scale known as the Medical Emergency Triage Treatment Scale (METTS), subsequently renamed the Rapid Emergency Triage Treatment Scale (RETTS©). Despite national widespread implementation, there has been limited research on METTS/RETTS©.AimTo determine the reliability of application by registered nurses of the RETTS© triage scale in two Swedish emergency departments.MethodsIn this prospective, cross-sectional study at two EDs, 46 written patient scenarios were triaged by 28 registered nurses (RNs). Data were analysed with descriptive statistics and Fleiss kappa (κ).ResultsThe RNs allocated 1281 final triage levels. There was concordance in seven (15%) of the scenarios, and dispersion over two or more triage levels in 39 (85%). Dispersion across the stable/unstable patient boundary was found in 21 (46%) scenarios. Fleiss κ was 0.562, i.e. moderate agreement.ConclusionThe inability of the triage scale to distinguish between stable/unstable patients can lead to serious consequences from a patient safety perspective. No general pattern regarding concordance or dispersion was found.
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| 3. |
- Wireklint, Sara, et al.
(author)
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A longitudinal, retrospective registry-based validation study of RETTS(©), the Swedish adult ED context version
- 2022
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central (BMC). - 1757-7241. ; 30:1
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Journal article (peer-reviewed)abstract
- Background: Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. The Rapid Emergency Triage and Treatment System (RETTS(©)), with annual updates, is the most applied triage system. However, the national implementation has been performed despite low scientific foundation for triage as a method, mainly related to the absence of adjustment to age and gender. Furthermore, there is a lack of studies of RETTS(©) in Swedish ED context, especially of RETTS(©) validity. Hence, the aim the study was to determine the validity of RETTS(©). Methods: A longitudinal retrospective register study based on cohort data from a healthcare region comprising two EDs in southern Sweden. Two editions of RETTS(©) was selected; year 2013 and 2016, enabling comparison of crude data, and adjusted for age-combined Charlson comorbidity index (ACCI) and gender. All patients >= 18 years visiting either of the two EDs seeing a physician, was included. Primary outcome was ten-day mortality, secondary outcome was admission to Intensive Care Unit (ICU). The data was analysed with descriptive, and inferential statistics. Results: Totally 74,845 patients were included. There was an increase in patients allocated red or orange triage levels (unstable) between the years, but a decrease of admission, both to general ward and ICU. Of all patients, 1031 (1.4%) died within ten-days. Both cohorts demonstrated a statistically significant difference between the triage levels, i.e. a higher risk for ten-day mortality and ICU admission for patients in all triage levels compared to those in green triage level. Furthermore, significant statistically differences were demonstrated for ICU admission, crude as well as adjusted, and for adjusted data ten-day mortality, indicating that ACCI explained ten-day mortality, but not ICU admission. However, no statistically significant difference was found for the two annual editions of RETTS(©) considering ten-day mortality, crude data. Conclusion: The annual upgrade of RETTS(©) had no statistically significant impact on the validity of the triage system, considering the risk for ten-day mortality. However, the inclusion of ACCI, or at least age, can improve the validity of the triage system.
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| 4. |
- Wireklint, Sara, et al.
(author)
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An updated national survey of triage and triage related work in Sweden : a cross-sectional descriptive and comparative study
- 2021
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 29:1
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Journal article (peer-reviewed)abstract
- BackgroundTriage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. According to two national surveys from 2005 to 2011, triage was carried out with different triage scales and without guidelines or formal education. Furthermore, a review from 2010 questioned the scientific evidence for both triage as a method as well as the Swedish five level triage scale Medical Emergency Triage and Treatment System (METTS); nevertheless, METTS was applied in 65% of the EDs in 2011. Subsequently, METTS was renamed to Rapid Emergency Triage and Treatment System (RETTS©). The hypothesis for this study is that the method of triage is still applied nationally and that the use of METTS/RETTS© has increased. Hence, the aim is to describe the occurrence and application of triage and triage related work at Swedish Emergency Departments, in comparison with previous national surveys.MethodsIn this cross-sectional study with a descriptive and comparative design, an electronic questionnaire was developed, based on questionnaire from previous studies. The survey was distributed to all hospital affiliated EDs from late March to the middle of July in 2019. The data was analysed with descriptive statistics, by IBM SPSS Statistics, version 26.ResultsOf the 51 (75%) EDs partaking in the study, all (100%) applied triage, and 92% used the Swedish triage scale RETTS©. Even so, there was low concordance in how RETTS© was applied regarding time frames i.e., how long a patient in respective triage level could wait for assessment by a physician. Additionally, the results show a major diversion in how the EDs performed education in triage.ConclusionThis study confirms that triage method is nationally implemented across Swedish EDs. RETTS© is the dominating triage scale but cannot be considered as one triage scale due to the variation with regard to time frames per triage level. Further, a diversion in introduction and education in the pivotal role of triage has been shown. This can be counteracted by national guidelines in what triage scale to use and how to perform triage education.
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| 5. |
- Wireklint, Sara
(author)
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Emergency Department Triage in Sweden : Occurrence, Validity, Reliability and Registered Nurses' Experiences
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim was to explore Emergency Department triage in Swedenthrough a specific focus on the Swedish triage system, RETTS© and RegisteredNurses’ experience of triage.Methods: Study I was a cross-sectional, prospective, national survey. Fiftyone(75%) EDs completed a digital questionnaire about triage and triage relatedwork. Study II was longitudinal, retrospective, register-based. In total 74,845patient ED visits were extracted, two annual cohorts from two EDs. Study IIIwas cross-sectional, 28 RNs from two EDs allocated triage levels on 46authentic patient scenarios. Study IV was descriptive, inductive, based on semistructuredinterviews with 14 RNs representing different parts of Sweden andlevels of hospitals. Descriptive (I, II, III), inferential (II), kappa statics (III), andinductive content analyses (IV) were applied.Results: Triage is firmly implemented in Swedish EDs and the Swedish triagesystem, RETTS© is the most commonly applied system but with variation on howRETTS© is applied or taught. RETTS© demonstrated no statistically significantdifference between the annual upgrades regarding ten-day and 72-hour mortality,but for admission to intensive care unit (ICU). Statistically significant differencewas demonstrated for mortality when data was adjusted for gender, age andcomorbidity. There was a statistically significant difference between the triagelevels for all outcomes. An inability to distinguish between stable/unstable patientwas demonstrated when 21/46 scenarios were triaged over this boundary. RETTS©reliability was moderate with κ=0.562. Furthermore, the RNs experience of triagewas described as A Balancing Act of an Ambiguous Assignment, a movementbetween uncomplicated and complex assessments performed with visible andimplicit prerequisites and in time perspectives that is both unpredictable andpredictable.Conclusion: Triage is performed in the majority of Swedish EDs and RETTS© isthe most commonly applied triage system, however, without a unanimous approach.The annual upgrade of RETTS© do not improve the ability to identify risk for shorttermmortality, but for admission to ICU. Furthermore, RETTS© reliability wasmoderate, and the RNs considered triage as a balancing act, a performance that hasto result in a safe assessment of the patient’s needs.
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| 6. |
- Wireklint, Sara, et al.
(author)
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Health-related quality of life after tonsillotomy versus tonsillectomy in young adults : 6 years postsurgery follow-up
- 2012
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In: European Archives of Oto-Rhino-Laryngology. - New York, USA : Springer. - 0937-4477 .- 1434-4726. ; 269:8, s. 1951-1958
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Journal article (peer-reviewed)abstract
- The indication for tonsil surgery is tonsillitis or obstructive symptoms due to tonsillar hypertrophy, associated with morbidity affecting health related quality of life (HRQL). Surgery performed is either tonsillectomy (TE) or partial intra capsular tonsillectomy/tonsillotomy (TT). TT is associated with fewer postoperative complications and rapid recovery, but with risk for regrowth of tonsillar tissue and return of sleep disordered breathing (SDB) or infections. The aim of this study was to investigate the long-term effects of TT and TE in young adults relating to HRQL and well-being as consequence of obstructive symptoms or ENT-infections after 6 years versus effect after 1 year. Young adults with symptoms of tonsillar hyperplasia were randomized to TE (44) or TT (32). Patients were assessed prior to surgery and 1 and 6 years postoperatively. Short Form 36 and the EuroQul Visual Analog Scale evaluated HRQL. Questionnaire was used to explore well-being, obstruction symptoms and infections. Patient BMI was calculated. Six years after surgery, 91 % of young adults (TE39/TT29) reported persisting benefits in well-being, reduced obstructive problems and fewer infections. Some patients in both groups reported a slight increase in snoring compared to 1 year after surgery, but still less than before surgery. Obesity was more frequent among those snoring. Both TT and TE in young adults yielded HRQL improvements and reduction in symptoms defining SDB persisting through 6 years postsurgery. Results indicated that both surgical methods were equally effective. Findings favor choice of TT due to lesser postoperative morbidity.
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