• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.11
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• pp.626-634
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• 2018

This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

• Journal of Convergence for Information Technology
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• v.10 no.4
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• pp.98-103
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• 2020

The purpose of this study was to determine whether the results of KTAS(Korean Triage and Acuity Scale) triage classifier differ according to the occupations. We analyzed a total of 10,960,359 cases of data sent to the NEDIS from January 1st, 2016 to December 31th, 2017. The triage classifier were MD(Medical Doctor), R(Resident), INT(Intern), GP(General Practitioner), RN(Registered Nurses) and EMT(Emergency Medical Technician). The consistency between the initial triage and final triage results was the highest GP(98.9%) and the lowest INT(80.2%). The results of over-triage classification was the lowest by GP(0.6%) and the highest for INT(16.0%). Also, the results of under-triage classification was the lowest by MD, EMT(0.4%) and the highest for INT(3.8%). The results of KTAS triage classifier significantly differ from according to the occupations(p<0.001). Triage classification should not differ from according to occupations and skill. It is necessary to strengthen the classifier's capacity for accurate triage classifications.

• The Korean Journal of Emergency Medical Services
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• v.25 no.3
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• pp.71-80
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• 2021

Purpose: The purpose of this study is to investigate the characteristics and appropriateness of the Korean-type severity classification by ambulance based on the medical records of 43,561 emergency patients who were brought to the emergency medical center via ambulance between January 1, 2015 and December 31, 2017. Methods: This study analyzed the classification characteristics of the Korean severity classification tool by applying them to emergency patients who visited the emergency medical center. Results: As a result of the study first, among the categories of home hospitals according to the results of visits, "other," "low consciousness," and "dyspnea" in the order of 129 ambulances were statistically significantly higher. In the order of "low consciousness" and "trauma," the "trauma" category was 5.3% higher than that of 129 ambulances. Conclusion: Among the classification items, "others," "low consciousness," and "dyspnea" were significantly higher in the group of patients who boarded 129 ambulances, and "others," "low consciousness," and "traumatic" were significantly higher in the 119 ambulances.

• Journal of Digital Convergence
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• v.17 no.2
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• pp.217-230
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• 2019

This study was conducted to develop a customized severity-adjustment method and to evaluate their validity for acute myocardial infarction(AMI) patients to complement the limitations of the existing severity-adjustment method for comorbidities. For this purpose, the subjects of KCD-7 code I20.0 ~ I20.9, which is the main diagnosis of acute myocardial infarction were extracted using the Korean National Hospital Discharge In-depth Injury survey data from 2006 to 2015. Three tools were used for severity-adjustment method of comorbidities : CCI (charlson comorbidity index), ECI (Elixhauser comorbidity index) and the newly proposed CCS (Clinical Classification Software). The results showed that CCS was the best tool for the severity correction, and that support vector machine model was the most predictable. Therefore, we propose the use of the customized method of severity correction and machine learning techniques from this study for the future research on severity adjustment such as assessment of results of medical service.

• Journal of the Korea Society of Computer and Information
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• v.16 no.1
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• pp.175-182
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• 2011

This study proposes CAOPI(Computer Aided Organ Prediction Index) system based on APACHE II(Acute Physiology And Chronic Health Evaluation) for classifying disease severity and predicting the conditions of patients' major organs. The existing ICU disease severity evaluation is mostly about calculating risk scores using patients' data at certain points, which has limitations on making precise treatments. CAOPI system is designed to provide personalized treatments by classifying accurate severity degrees of emergency patients, predicting patients' mortality rate and scoring the conditions of certain organs.

• Journal of Korean Clinical Nursing Research
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• v.24 no.1
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• pp.94-102
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• 2018

Purpose: The purpose of this study was to examine triage nurses' the Korean triage and acuity scale(KTAS) performance ability, perception of importance, education needs and identify the factors influencing triage nurses' the KTAS performance ability. Methods: A descriptive correlational study was conducted among 146 emergency nurses working in 13 hospitals from March to May, 2017. Data were collected utilizing a questionnaire developed to measure performance ability, perception of importance, and educational needs of 192 items of the KTAS. Statistical analysis included t-test, analysis of variance, correlation analysis and multiple regression analysis. Results: The triage nurses' the KTAS performance ability was rated as 3.3/4.0 points, perception of importance as 3.2/4.0 points, and education needs as 3.1/4.0 points. Factors influencing the KTAS performance of the participants were perception of importance, education needs, and work experience at the emergency department, explaining 26.7% of total variance. Conclusion: The KTAS performance ability of triage nurses could be improved through training programs designed to enhance their perception of importance and provide knowledge about the KTAS. Nurses' emergency department work experience needs to be considered as an important factor for the KTAS performance ability.

• Journal of East-West Nursing Research
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• v.26 no.1
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• pp.91-99
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• 2020

Purpose: The study aims to assess the inter-rater reliability of the Korean Triage and Acuity Scale between the research nurses and the triage nurses. Methods: Interrater reliability was measured on 400 adult (≧15) and 400 pediatric (<15) patients who visited the emergency medical center from January 4 to June 30, 2018. Results: The study result showed that the inter-rater reliability of the Korean Triage and Acuity Scale was substantial, with κ=.73 (95% Confidence interval= .68-.78) and 77.0 percent agreement. The inter-rater of Pediatric Korean Triage and Acuity Scale was also substantial, with κ=.76 (95% Confidence interval= .71-.82) and 83.8 percent agreement. Conclusion: Although the inter-rater reliability of the Korean Triage and Acuity Scale was acceptable, the percent agreement was lower than the desirable level (<80.0%). It was confirmed that Pediatric Korean Triage and Acuity Scale had an acceptable level of inter-rater reliability and percent agreement for clinical use. Efforts should be made to improve the reliability in the future.

• Journal of Korean Academy of Nursing
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• v.49 no.1
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• pp.26-35
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• 2019

Purpose: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). Methods: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. Results: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. Conclusion: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

• Journal of Korean Clinical Nursing Research
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• v.26 no.1
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• pp.107-116
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• 2020

Purpose: This study was a prospective survey to evaluate the Korean Triage and Acuity Scale (KTAS) inter-rater reliability and to identify discordant areas in the KTAS classification between nurses and paramedics in emergency department (ED). Methods: Inter-rater reliability were evaluated using triage deta from January 11 to May 31, 2019. A convinience sample of a total of 800 patients who visited an emergnecy medical center in Incheon (400 adult and 400 pediatric patients in this study) were selected. The triages of this study a pair of one nurse and one paramedic performed triage at the same time, using the KTAS, Inter-rater reliability for the KTAS was evaluated with the weighted kappa. Results: The inter-rater reliability of the KTAS evaluated by weighted Kappa between nurse-paramedic KTAS score of adult patients was .71, and .66 for pediatric patients. Both were in the level considered as substantial. Among causes of triage discordance, the most frequently identified discordant item in triaging adults was the difference in the measurement of pain intensity (28.0%). For both adult and pediatric patients, multiple chief complaint was identified as the major discordant factor. In triaging pediatric patients the body temperature assessment by subjective judgments was the highest discordant item (50.7%). Conclusion: The study result suggested that the KTAS demonstrated a reasonable level of inter-rater reliability and functioned as a standardized triage tool for emergency medical services. In order to improve the inter-rater reliability and classification competence, it is necessary to revise the current all-integrated KTAS provider course to be differentiated for each job group.

• Journal of Korean Clinical Nursing Research
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• v.26 no.3
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• pp.395-406
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• 2020

Purpose: The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. Methods: The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. Results: Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. Conclusion: Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.