Risk classification priorities in an emergency unit and outcomes of the service provided.
Rafael Silva Marconato, Maria Ines Monteiro
PMID 29267545WHAT IT FOUND
Emergency nurses' four-color risk classification was associated with service outcomes.
Red patients had the most deaths, and many deaths occurred in patients who were not classified. Green and blue patients were mostly discharged, so triage records alone may not show every high-risk patient.
Key findings
01The risk classification assigned by nurses was associated with service outcome, patient age, length of stay and arrival time.
02Red patients had the highest death count (172), followed by unclassified patients (105) and yellow patients (51).
0335,653 consultations (36.9%) had no risk classification, including patients sent directly to the emergency room before evaluation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data were extracted retrospectively from administrative records, so the authors note the recorded information may not fully match what happened clinically. A large share of consultations had no risk classification, including patients sent directly to the emergency room, so the protocol was not applied to every arrival. The outcomes were administrative service endpoints (death, hospitalization or discharge), not measures of diagnostic accuracy, treatment quality or patient recovery. The study was conducted in a single Brazilian emergency unit, so the mix of patients and workflows may not fit other services. Some variables had 'not informed' entries, so the totals for outcomes, age, length of stay and arrival time do not all add to the same number of consultations.
The easy way to misread this
Do not conclude that the triage protocol caused better outcomes or that it is clinically validated. The study used administrative records from one emergency unit, and 31.4% of deaths happened in patients who had not been risk-classified because they were sent directly for care.