title: Quality in triage: indicators in patients with respiratory disease.
abstract: OBJECTIVE
  The objective was to apply quality indicators in respiratory disease triage during a set time period.
  
  
  METHODS
  This was a retrospective, descriptive, and comparative study of all patients attending the emergency department of Acosta Ñu Children's Hospital with breathing difficulty, between January 1 and July 31, 2011.
  
  
  RESULTS
  Two thousand five hundred eighty-two patients were included in the study. The delay in medical care according to severity of breathing difficulty was as follows: for critical patients, 1 minute (100% compliance); for emergencies, 6.4 minutes (93.4% compared with 95% standard); for urgencies, 15.8 minutes (90% compared with the standard 90%); and for semiurgencies, 35 minutes (92.4% vs. 85% standard). Regarding to the admission-triage time indicator: mean time was 6.1 minutes; 2220 patients (86%) were classified in less than 10 minutes from the time of hospital admission, and 2453 (95%) were evaluated before 15 minutes. Respiratory rate was recorded in 2368 patients (91.7%), and pulse oximetry in 2443 (94.6%). Both parameters were recorded in 2271 children (88%). Errors in classification were detected, mainly tendency to underestimate the risk or exacerbate the clinical situation; 441 patients underwent subtriage (20.5%), and 44 overtriage (1.7%). There were drawbacks to classify emergencies error rate 45.8% (P < 0.00001). Relationship between pathophysiologic diagnosis and triage level was significant (P < 0.00001).
  
  
  CONCLUSIONS
  Indicators of triage quality were acceptably met in respiratory disease. Breathing difficulty was identified and classified as urgent, although problems arouse at differentiation between moderate and severe dyspnea.
authors.affiliation: Pediatric Emergency, Children of Acosta Ñu General Pediatric Hospital, San Lorenzo, Paraguay. silvina.lugo@hotmail.com
authors.forename: Silvina Elizabeth
authors.initials: SE
authors.lastname: Lugo
authors.forename: Viviana
authors.initials: V
authors.lastname: Pavlicich
mesh_terms: D001982:Bronchial Diseases / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004417:Dyspnea / Q000209:etiology; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007827:Laryngitis / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D010092:Oximetry / Q000706:statistics & numerical data; D010239:Paraguay / Q000453:epidemiology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D012120:Respiration Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D056152:Respiratory Rate; D012189:Retrospective Studies; D013224:Status Asthmaticus / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data