Bedeutung der Triage in der klinischen Notfallmedizin

Zusammenfassung

In Notaufnahmen stellen sich Patienten mit unterschiedlich ausgeprägten Erkrankungen bzw. Verletzungen vor. Notfallpatienten mit Bagatellerkrankungen bzw. mit komplexen Beschwerdebildern konkurrieren im gleichen Umfang um die vorgehaltenen personellen und strukturellen Ressourcen. Prinzipiell sollte die Diagnostik und Therapie bei jedem Patienten zeitnah durchgeführt werden, unabhängig vom Schweregrad der Erkrankung oder Verletzung. Eine unerwartete, hohe Zahl an Notfallpatienten kann die vorgehaltenen Ressourcen überschreiten. Dadurch verzögert sich die Patientenversorgung unweigerlich. Um kritisch kranke Patienten in Zeiten von Überlast korrekt zu erkennen, müssen die Betroffenen bereits bei der Vorstellung identifiziert und zum richtigen Zeitpunkt der richtigen Behandlung zuzugeführt werden. Seit Mitte der 1960er Jahre wurde – beginnend in Australien und den USA – schrittweise in Notaufnahmen eine „Pflegegestützte Triage“ eingeführt. Es handelt sich hierbei um einen komplexen Entscheidungsprozess, der hilft, Patienten mit zeitkritischem Handlungsbedarf strukturiert zu erkennen. Die Vor- und Nachteile sowie die Limitationen der in Deutschland eingeführten 5-stufigen Triagesysteme, „Emergency Severity Index“ und „Manchester Triage System“, werden diskutiert und in den Kontext des deutschen Systems der Notfallversorgung eingeordnet. Außerdem werden Optionen zur weiteren Optimierung der Triagesysteme dargestellt, z. B. die Teamtriage oder die Implementierung des „Early Warning Scores“. Zusammenfassend ist die Triage ein klinisches Instrument, das die Patientensicherheit in der klinischen Notfallmedizin erhöht hat. Eine systematische und strukturierte Ersteinschätzung der Behandlungsdringlichkeit durch Triagesysteme wird von nationalen und internationalen notfallmedizinischen Fachgesellschaften empfohlen und sollte auch in Deutschland zum Standard werden.

Abstract

In emergency departments, patients present with different severities of diseases and traumatic injuries. However, patients with severe and life-threatening conditions compete for the same resources such as personal and structure. As a general rule, each patient should receive immediate diagnostic and treatment, independent of his or her severity of disease or traumatic injury. However, an unexpected number of patients presenting to the emergency department at the same time may exceed available resources. Thus, waiting times will occur and management of patients may be impeded. As a consequence, patients with diseases or traumatic injuries with a need for time-critical management, have to be detected at the time of presentation. After categorization, patients have to be prioritized and guided to the correct place of treatment („triage“). Starting in Australia and the United States, nurse-driven triage systems have been introduced in the emergency departments. Aim of triage is to correctly identify at increased risk of death and guide them to rapid and correct treatment. In Germany, two five-level triage systems have been introduced: Manchester Triage System (MTS) and Emergency Severity Index (ESI). We give an overview of these risk assessment tools and discuss pros and cons. In addition, new options such as “team triage” and a combination with „Early Warning Scores“ are reported. In summary, nurse-driven triage is an instrument to improve patient safety in emergency medicine. A structured and systematic triage of patients using validated triage assessment tools are recommended from national and international societies of emergency medicine. Therefore, nurse-driven triage is also a must in Germany.

Schlüsselwörter

Notaufnahme - Triage - Manchester Triage System - Notfalltriage - Emergency Severity Index

Keywords

emergency department - triage - emergency triage - Manchester Triage System - Emergency Severity Index

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