The Emergency Severity Index (ESI) is a triage tool used for patient assessment in the emergency department  (ED). The ESI rates patients based on acuity and predicted resource requirement, from level 1 (resuscitation) to level 5 (non urgent). The Japan triage and acuity scale (JTAS) is frequently used for emergency patients, and the ESI has not been evaluated against the JTAS in Japan. This study aimed to examine differences in urgent decision accuracy in simulated scenarios with triage nurses using the ESI and JTAS. A parallel-group randomized trial was conducted. Eighteen JTAS-trained triage nurses, from 3 Japanese EDs, were randomly assigned to the ESI group or JTAS group. Nurses independently assigned triage scores to 100 emergency cases. Four indexes were used: accuracy, each urgency accuracy of rating individual category-stage, answer time, and a subjective usability. There were no significant differences in age, clinical experience, or JTAS experience between groups. A quadratically weighted kappa was used to measure inter-observer reliability; the ESI was superior to the JTAS in concordance rate (0.82 [0.80-0.85] and 0.74 [0.71-0.77], respectively). For all rating categories, except level 5, the Fleiss’ κ was higher in the ESI group. The ESI was more sensitive for category level 2, as an indication of high-risk situations, than the JTAS. However, no significant difference showed in answer time or usability. These findings suggest that the ESI could be a more useful triage tool, and has a greater sensitivity for detecting patient abnormalities in Japanese EDs than the JTAS.

Background: To reduce the burden on doctors, our center restructured the responsibilities of a doctor clerk (DC) in 2016. In the 2018 fiscal year, the number of DCs increased from one to two. In this study, we examined the effects of this restructuring process.

Methods: The following were examined before and after the restructuring, as well as after the increase in the number of DCs: the number of patient claims, substitutions of primary care orders, records, case registries, and medical documents processed by DCs; along with doctors’ overtime, demand rate of admitted patients, and doctors’ satisfaction.

Results: After the restructuring, the number of documents and records processed by DCs increased. As many administrative tasks were delegated to DCs, the number of admitted patients increased by 6.7%, whereas doctors’ overtime rate decreased by 14%, resulting in an increase of doctors’ overall satisfaction.

Conclusions: The effective use of DCs reduced the burden on doctors and shifted their efforts to medical treatment. As workflow and efficiency improved in our institution, productivity and medical quality increased. Restructuring the role of DCs can potentially transform the way emergency physicians work.

In the hospital specializing in cardiovascular diseases, the proportion of encountering hospital cardiac arrest and sudden change correspondence is higher than in facilities and medical institutions in other areas. Since 2015, Hospital A, a cardiovascular special hospital, the BLS provider course for medical professionals has been introduced. However, since we were not able to grasp the present situation and needs of seminar about sudden change of co-medical staff who corresponded actually, we conducted a questionnaire survey. Finally, 163 staff responded. Approximately 70% of staff members had knowledge of BLS and experiences of sudden changes, but the percentage that I am confident in responding sudden changes was 20%. Many subjects needed training such as ACLS, cardiovascular management, communication skill and simulation. In addition to the BLS provider course, training that aims further skill improvement, incorporates simulation, according to more specific needs and current situation were needed.