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Open Access 01-12-2016 | Research article

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department

Authors: Alejandro Molina-López, Jeremy Bernardo Cruz-Islas, Mauricio Palma-Cortés, Diana Patricia Guizar-Sánchez, César Yehú Garfias-Rau, Martha Patricia Ontiveros-Uribe, Ana Fresán-Orellana

Published in: BMC Psychiatry | Issue 1/2016

Abstract

Background

Classification of Psychiatric Emergency Presentations (PEP) is not sufficiently clear due to their inherent high inter-subjectivity and lack of validated triage instruments. In order to improve current classification of psychiatric emergency presentations (PEP) at Emergency Departments, we implemented and validated the Color-Risk Psychiatric Triage (CRPT), an instrument for classifying PEP risk by sorting one to five color/risk levels and one to thirty-two possible conditions arranged by risk.

Methods

Users who visited the Emergency Department (ED) of a Mexican psychiatric hospital from Dec 1st, 2008 to Dec 1st, 2009 were included. One CRPT was assessed by an ED psychiatrist to each patient upon their arrival to ED. Some patients were randomly assessed simultaneously with an additional CRPT and a Crisis and Triage Rating Scale (CTRS) to test validity and reliability of the CRPT.

Results

A total of 7,631 CRPT assessments were included. The majority of PEP were non-urgent (74.28 %). For the validation phase n = 158 patients were included. CRPT score showed higher concurrent validity than CRPT color/risk. CRPT level/risk and score showed highest concurrent validity within dangerousness domain of CTRS (r = 0.703, p < 0.0001). CRPT and CTRS scores showed similar predictive validity (p < 0.0001). High intraclass correlation coefficient (0.982) and Cohen’s Kappa (0.89) were observed for CRPT score (r = 0.982, p < 0.0001).

Conclusions

CRPT appeared to be a useful instrument for PEP classification due to its concurrent validity, predictive validity and reliability. CRPT score showed higher correlations than the CRPT color/risk. The five levels of risk provided by the CRPT appear to represent a simple and specific method for classifying PEP. This approach considers actual or potential risk, rather than severity, as the main factor for sorting PEP, which improves upon the current approach to emergency classification that is mainly based on the criterion of severity. Regardless of the triage procedure, emergency assessments should no longer classify PEP as “not real emergencies.”

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Lowthian JA, Curtis AJ, Jolley DJ, Stoelwinder JU, McNeil JJ, Cameron PA. Demand at the emergency department front door: 10-year trends in presentations. Med J Aust. 2012;196:128–32. [doi:10.5694/mja11.10955]. [PubMed: 22304608.]CrossRefPubMed

Matsu CR, Goebert D, Chung-Do JJ, Carlton B, Sugimoto-Matsuda J, Nishimura S. Disparities in emergency department visits among youth in Hawaii, 2000-2010. J Pediatr. 2012;12:1020–7. Epub ahead of print. [doi:10.1016/j.jpeds.2012.09.006].

Van Der Post LF, Dekker JJM, Jonkers JF, Beekman AT, Mulder CL, de Haan L, et al. Crisis intervention and acute psychiatry in Amsterdam, 20 years of change: A historical comparison of consultations in 1983 and 2004-2005. Int J Soc Psychiatry. 2010;56(4):348–358. [doi:10.1177/0020764008098839]. [PubMed: 19617280.]CrossRefPubMed

Munk-Jørgensen P. Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci. 1999;249(3):136–43. [PubMed: 10433127].CrossRefPubMed

Bruffaerts R, Sabbe M, Demyttenaere K. Emergency psychiatry in the 21st century: critical issues for the future. Eur J Emerg Med. 2008;15(5):276–8. [doi:10.1097/MEJ.0b013e3282fc7616]. [PubMed: 18784506].CrossRefPubMed

Paradis M, Woogh C, Marcotte D, Chaput Y. Is psychiatric emergency service (PES) use increasing over time? Int J Ment Health Syst. 2009;3(1):3. [doi:10.1186/1752-4458-3-3]. [PubMed: 19192279].PubMedCentralCrossRefPubMed

Latt N, Jurd S, Tennant C, Lewis J, Macken L, Joseph A, et al. Alcohol and substance use by patients with psychosis presenting to an emergency department: changing patterns. Australas Psychiatry. 2011;19(4):354–359. [doi:10.3109/10398562.2011.579971]. [PubMed: 21851228].CrossRefPubMed

Lindsey MA, Joe S, Muroff J, Ford BE. Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. Gen Hosp Psychiatry. 2010;32(3):300–9. [doi:10.1016/j.genhosppsych.2010.01.007]. [PubMed: 20430234].PubMedCentralCrossRefPubMed

Boudreaux ED, Niro K, Sullivan A, Rosenbaum CD, Allen M, Camargo Jr CA. Current practices for mental health follow-up after psychiatric emergency department/psychiatric emergency service visits: a national survey of academic emergency departments. Gen Hosp Psychiatry. 2011;33(6):631–3. [doi:10.1016/j.genhosppsych.2011.05.020]. [PubMed: 21872940].CrossRefPubMed

10.

Paradiso S, Rudrauf D. Struggle for life, struggle for love and recognition: the neglected self in social cognitive neuroscience. Dialogues Clin Neurosci. 2012;14(1):65–75. [PubMed: 22577306].PubMedCentralPubMed

11.

Links PS, Eynan R, Ball JS, Barr A, Rourke S. Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality. Crisis. 2005;26(4):160–9. [PubMed: 16485841].CrossRefPubMed

12.

Chaput Y, Paradis M, Beaulieu L, Labonté É. A qualitative study of a psychiatric emergency. Int J Ment Health Syst. 2008;2(1):9. [doi:10.1186/1752-4458-2-9].PubMedCentralCrossRefPubMed

13.

Kennedy K, Aghababian RV, Gans L, Lewis CP. Triage: techniques and applications in decision making. Ann Emerg Med. 1996;28(2):136–44. [doi:10.1016/S0196-0644(96)70053-7]. [PubMed: 8759576].CrossRefPubMed

14.

Van der Wulp I, Van Baar ME, Schrijvers AJ. Reliability and validity of the Manchester Triage System in a general emergency department patient population in the Netherlands: results of a simulation study. Emerg Med J. 2008;25(7):431–4. [doi:10.1136/emj.2007.055228]. [PubMed: 18573959].CrossRefPubMed

15.

Beveridge R. CAEP issues. The Canadian Triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physicians. J Emerg Med. 1998;16(3):507–11 [PubMed: 9610988].CrossRefPubMed

16.

Brooker C, Ricketts T, Bennett S, Lemme F. Admission decisions following contact with an emergency mental health assessment and intervention service. J Clin Nurs. 2007;16(7):1313–22. [doi:10.1111/j.1365-2702.2007.01302.x]. [PubMed: 17584350].CrossRefPubMed

17.

Downey LV, Zun LS, Burke T. Comparison of Canadian triage acuity scale to Australian Emergency Mental Health Scale triage system for psychiatric patients. Int Emerg Nurs. 2014. Epub ahead of print [doi:10.1016/j.ienj.2014.06.006].

18.

Daniel C, Gerdtz M, Elsom S, Knott J, Prematunga R, Virtue E. Feasibility and need for violence risk screening at triage: an exploration of clinical processes and public perceptions in one Australian emergency department. Emerg Med J. 2014. Epub ahead of print [doi:10.1136/emermed-2013-202979] [PubMed: 25004918].

19.

Van Veen M, van Weeghel I, Koekkoek B, Braam AW. Structured assessment of suicide risk in a psychiatric emergency service: psychometric evaluation of the nurses’ global assessment of suicide risk Scale (NGASR). Int J Soc Psychiatry. 2014; epub [doi:10.1177/0020764014543311] [PubMed: 25061024].

20.

Smart D, Pollard C, Walpole B. Mental health triage in emergency medicine. Aust N Z J Psychiatry. 1999;33(1):57–66. [doi:10.1046/j.1440-1614.1999.00515.x]. [PubMed: 10197886, discussion 67].CrossRefPubMed

21.

Broadbent M, Moxham L, Dwyer T. The development and use of mental health triages in Australia. Int J Ment Health Nurs. 2007;16(6):413–21. [doi:10.1111/j.1447-0349.2007.00496.x]. [PubMed: 17995512].CrossRefPubMed

22.

Bengelsdorf H, Levy L, Emerson R, Barile FA. A crisis triage rating scale. Brief dispositional assessment of patients at risk for hospitalization. J Nerv Ment Dis. 1984;172(7):424–30.CrossRefPubMed

23.

Turner PM, Turner TJ. Validation of the Crisis Triage Rating Scale for psychiatric emergencies. Can J Psychiatry. 1991;36(9):651–4. [PubMed: 1773400].PubMed

24.

Gill JM, Reese IV CL, Diamond JJ. Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann Emerg Med. 1996;28(5):474–9. [doi:10.1016/S0196-0644(96)70108-7]. [PubMed: 8909266].CrossRefPubMed

25.

Roman JS, Griswold KS, Smith SJ, Servoss TJ. How patients view primary care: differences by minority status after psychiatric emergency. J Cult Divers. 2008;15(2):56–60. [PubMed: 18649441].PubMed

26.

Alyasin A, Douglas C. Int Emerg Nurs. 2014;22(4):220–5.CrossRefPubMed

27.

Ryan M, Spicer M, Hyett C, Barnett P. Non-urgent presentations to a paediatric emergency department: parental behaviours, expectations and outcomes. Emerg Med Australas. 2005;17(5-6):457–62. [doi:10.1111/j.1742-6723.2005.00777.x].CrossRefPubMed

28.

Murphy E, Kapur N, Webb R, Cooper J. Risk assessment following self-harm: comparison of mental health nurses and psychiatrists. J Adv Nurs. 2011;67(1):127–39. [doi:10.1111/j.1365-2648.2010.05484.x]. [PubMed: 20969616].CrossRefPubMed

29.

Love RA, Murphy JA, Lietz TE, Jordan KS. The effectiveness of a provider in triage in the emergency department: A quality improvement initiative to improve patient flow. Advancen emergency nursing. Adv Emerg Nurs J. 2012;34(1):65–74.CrossRefPubMed

30.

Broadbent M, Moxham L, Dwyer T. Implications of the emergency treatment triage environment on triage practice for clients with a mental illness at triage in an Australian context. Australas Emerg Nurs J. 2014;17(1):23–9. [doi:10.1016/j.aenj.2013.11.002].CrossRefPubMed

31.

Bullard MJ, Villa-Roel C, Bond K, Vester M, Holroyd BR, Rowe BH. Tracking emergency department overcrowding in a tertiary care academic institution. Healthc Q. 2009;12(3):99–106. [doi:10.12927/hcq.2013.20884].CrossRefPubMed

32.

Melton N, Mitchel M, Crilly J, Cooke M. Patient characteristics and institutional factors associated with those who “did not wait” at a South East Queensland Emergency Department: Who are those who “did not wait” in ED? Australas Emerg Nurs J. 2014;17(1):1–8.CrossRef

33.

Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, Keaschuck RA, et al. Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care. Acad Emerg Med. 2010;17(2):177–186. [doi:10.1111/j.1553-2712.2009.00633.x].CrossRefPubMed

34.

Clarke DE, Brown AM, Hughes L, Motluk L. Education to improve the triage of mental health patients in general hospital emergency departments. Accid Emerg Nurs. 2006;14(4):210–8. [doi:10.1016/j.aaen.2006.08.005.] PubMed: 17067798.CrossRefPubMed

35.

Schuch JJ, Roest AM, Nolen WA, Penninx BW, de Jonge P. Gender differences in major depressive disorder: results form the Netherlands study of depression and anxiety. J Affect Disord. 2014;156:153–63.

36.

Burnett-Zeigler I, Kim HM, Chiang C, Kavanagh J, Zivin K, Rockefeller K, et al. The association between race and gender, treatment attitudes, and antidepressant treatment adherence. Int J Geriatr Psychiatry. 2014;29(2):169–177. [doi:10.1002/gps.3984]. [PubMed: 23801324].CrossRefPubMed

37.

McAlpine DD, Mechanic D. Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. Health Serv Res. 2000;35(1 Pt 2):277–92. [PubMed: 10778815].PubMedCentralPubMed

38.

Erbay H, Alan S, Kadioglu S. Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey. Nurs Ethics. 2013;21(5):530–9. [doi:10.1177/0969733013505311].CrossRefPubMed

39.

Farrohknia N, Castrén M, Ehrenberg A, Lind L, Oredsson S, Jonsson H, et al. Emergency Department Triage Scales and their components: A systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med. 2011;19:42. [doi:10.1186/1757-7241-19-42]. [PubMed: 21718476].PubMedCentralCrossRefPubMed

40.

Pinto T, Poynter B, Durbin J. Medical clearance in the psychiatric emergency setting: A call for more standardization. Healthc Q. 2010;13(2):77–82. [doi:10.12927/hcq.2013.21674]. [PubMed: 20357550].CrossRefPubMed

41.

Baca-García E, Perez-Rodriguez MM, Basurte-Villamor I, Saiz-Ruiz J, Leiva-Murillo JM, de Prado-Cumplido M, et al. Using data mining to explore complex clinical decisions: A study of hospitalization after a suicide attempt. J Clin Psyhciatry. 2006;67(7):1124–32.CrossRef

42.

Marciano R, Mullis DM, Jauch EC, Carr CM, Raney L, Martin RH, et al. Does targeted education of emergency physicians improve their comfort level in treating psychiatric patients? West J Emerg Med. 2012;13(6):453–457. [doi:10.5811/westjem.2012.3.6899]. [PubMed: 23359642].PubMedCentralCrossRefPubMed

43.

Bredin SSD, Gledhill N, Warburton DER. New risk stratification and physical activity strategy for physicians and patients alike. Can Fam Physician. 2013;59(3):273–7.PubMedCentralPubMed

44.

Barret B, Waheed W, Farrelly S, Birchwood M, Dunn G, Flach C. Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: economic outcomes. PLOS ONE. 2013;8(11):e74210. [doi:10.1371/journal.pone.0074210].CrossRef

Title: Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department
Authors: Alejandro Molina-López
Jeremy Bernardo Cruz-Islas
Mauricio Palma-Cortés
Diana Patricia Guizar-Sánchez
César Yehú Garfias-Rau
Martha Patricia Ontiveros-Uribe
Ana Fresán-Orellana
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-016-0727-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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