Introduction: Neurological emergencies pose a significant challenge in emergency departments, where timely care and treatment are crucial for patient survival. Triage of neurological conditions is complex, as vital signs often do not reflect the severity of the illness. The Manchester Triage System plays a key role in the rapid identification of urgent cases, yet due to the complexity of these conditions, triage errors may occur. Consistency between the triage urgency level and the final physician's assessment is essential for effective treatment and improved patient outcomes. Purpose: The aim of this master's thesis was to analyze the agreement between the urgency level determined during the triage process performed by nurses and the final urgency level based on the physician’s diagnosis for patients treated in a neurological emergency department. Methods: In the study, we compared the triage and final urgency levels of 360 patients treated in a neurological emergency department between October 1 and 13, 2024. Data were collected on triage, initial and final urgency levels, and other diagnostic methods. The questionnaire also included the nurses' self-assessment of their confidence level based on a numerical scale. Data were analyzed using statistical tests (Wilcoxon test, χ² test, Spearman's correlation coefficient) to examine agreement and factors influencing the triage assessment. The study included 13 healthcare professionals. Results: The triage and physician-assessed urgency levels had the same median value (3), but the difference between them was statistically significant (Z = -2.119, p = 0.034), as physicians more frequently assigned higher urgency levels. Most transitions between triage categories were stable, while upward shifts indicated progression to more critical categories. The number and type of diagnostic tests, years of service, triage training, and education level did not influence the agreement between assessments (p > 0.05). Discussion and conclusion Discrepancies between the nurse’s triage assessment and the physician’s final evaluation were mainly present in less complex cases. Despite these inconsistencies, the nurses’ assessments were generally aligned with those of the physicians. Factors such as diagnostic tests, work experience, triage training, and education level did not influence the level of agreement. To enhance consistency and optimize patient care, it is important to consider factors such as experience, triage training, and knowledge verification of nurses. The study enabled the development of a model for verifying urgency assessment agreement, which—with further refinement and validation—could be crucial for effective and timely care, particularly in neurological emergencies where every moment is critical.
|
