Eric D. Carlström

Manchester Triage in Sweden – Interrater reliability and accuracy

INTRODUCTION This study investigates the interrater reliability and the accuracy of Manchester Triage (MTS) at emergency departments in Western Sweden. METHODS A group of 79 nurses from seven emergency departments assessed simulated patient cases and assigned triage categories using the same principles as in their daily work. K statistics, accuracy, over-triage and under-triage were then analyzed. The nurses performed 1027 triage assessments. RESULTS The result showed an unweighted kappa value of 0.61, a linear weighted kappa value of 0.71, and a quadratic weighted kappa value of 0.81. The determined accuracy was 92% and 91% for the two most urgent categories, but significantly lower for the less urgent categories. CONCLUSIONS Patients in need of urgent care were identified in more than nine out of 10 cases. The high level of over-triage and under-triage in the less urgent categories resulted in low agreement and accuracy. This may suggest that the resources of emergency departments can be overused for non-urgent patients.

From artefact to effect : the organising effects of artefacts on teams

PURPOSE Earlier studies have identified artefacts, but have only to a lesser degree looked at their effects. The purpose of this paper is to investigate how artefacts contribute to organisation. DESIGN/METHODOLOGY/APPROACH A trauma team at a university hospital has been observed and its members interviewed. FINDINGS The trauma team showed itself to be rich on artefacts since it had strong internal driving forces, high legitimacy, and tried to live up to high expectations from the outside. Its members were motivated to be in the forefront of trauma care. Through renewal, the team succeeded in maintaining demarcation. It also succeeded in systemising internal work tasks and made for itself a position in relation to the outside. The teams capacity, however, came to be limited by internal conflicts and battles for prestige. PRACTICAL IMPLICATIONS The study shows that informal logic has a strong influence on teams. Teamwork contributed to the development of organisational structure and motivation for the personnel. ORIGINALITY/VALUE Earlier studies advocate the important role of artefacts in order to communicate, collaborate, negotiate or coordinate activities. The conclusion is that artefacts also have an organising and developing effect on teams in a fragmented and differentiated healthcare.

The yellow line: a critical study of the symbolic value of artefacts in health care teams

Artefacts reveal an organisation’s “inner life” and they contribute to its image and reputation. They also play a decisive role for an organisation’s development. In this article, similar artefacts from two different health care teams—a trauma team and a psychiatric team—in the same hospital, are compared. The team members were interviewed and their work observed over the course of several years. It was demonstrated that identical pieces of equipment in a trauma team and a psychiatric team signalled opposite values. The psychiatric team was backward-looking, conservative and contradictory. Modern technology and pieces of equipment were associated with an abandoned and previously criticised activity. The corresponding equipment in the trauma team, on the other hand, signalled a forward looking, developing and unified culture. The trauma team was a relatively new and powerfully idealised phenomenon, which attracted attention. The analysis points out how the symbolic values signal that one activity is attractive and pleasing while another has a low external legitimacy.