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      Electronic and manual registration of Manchester System: reliability, accuracy, and time evaluation* Translated title: Registro eletrônico e manual do Sistema Manchester: avaliação da confiabilidade, acurácia e tempo despendido Translated title: Registro electrónico y manual del Sistema Manchester: evaluación de la confiabilidad, precisión y tiempo utilizado

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          Abstract

          Objective:

          to evaluate the degree of reliability, accuracy and timing to perform the Manchester Triage System in electronic and manual records.

          Method:

          exploratory-descriptive research. Case series corresponded to a total of 20 validated simulated clinical cases applied to a sample of 10 nurses. For data collection each participant received 4 clinical cases in 2 different phases of the study, using manual and electronic registration. The variables related to the triage were: incomplete data filling, discriminator, flowchart, priority level, vital signs and triage timing.

          Results:

          moderate reliability for choosing flowcharts and substantial reliability for determining discriminators in both records; substantial and moderate, for priority, respectively, in manual and electronic registration. For vital signs, it was weak in manual recording and substantial in electronic. Accuracy showed a statistically significant difference related to vital signs. The average timing on triage was shorter with the use of electronic registration.

          Conclusion:

          the use of electronic registration has advantages regarding reliability, accuracy and timing to perform the triage, pointing to the importance of adopting technologies in the management and care work process in health services.

          Translated abstract

          Objetivo:

          Avaliar o grau de confiabilidade, acurácia e tempo despendido para realização do Sistema Manchester de Classificação de Risco em registros eletrônico e manual.

          Método:

          exploratório-descritivo. Casuística do estudo correspondeu ao total de 20 casos clínicos simulados validados aplicados para amostra de 10 enfermeiros. Para coleta de dados cada participante recebeu 4 casos clínicos em 2 diferentes fases do estudo, com uso em registro manual e eletrônico. As variáveis relacionadas à classificação de risco foram: preenchimento incompleto dos dados, discriminador, fluxograma, nível de prioridade, sinais vitais e tempo despendido com classificação de risco.

          Resultados:

          Confiabilidade moderada para escolha dos fluxogramas e substancial para determinação dos discriminadores em ambos os registros; substancial e moderada, para prioridade, respectivamente, no registro manual e eletrônico. Para sinais vitais, apresentou-se fraca no registro manual e substancial no eletrônico. A acurácia apresentou diferença estatisticamente significante relacionada aos sinais vitais. A média de tempo despendido com a classificação de risco foi menor com utilização do registro eletrônico.

          Conclusão:

          O uso do registro eletrônico apresenta vantagens referentes à confiabilidade, acurácia e tempo despendido para a realização da classificação de risco, indicando a importância da adoção de tecnologias no processo de trabalho gerencial e assistencial nos serviços de saúde.

          Translated abstract

          Objetivo:

          evaluar el grado de confiabilidad, precisión y tiempo utilizado para realización del Sistema Manchester de Clasificación de Riesgo en registros electrónico y manual.

          Método:

          exploratorio y descriptivo. La casuística del estudio correspondió al total de 20 casos clínicos simulados, validados y aplicados en una muestra de 10 enfermeros. Para la recolección de datos cada participante recibió 4 casos clínicos, en 2 diferentes fases del estudio, utilizando registro manual y electrónico. Las variables relacionadas a la clasificación de riesgo fueron: llenado incompleto de datos, discriminador, diagrama de flujo, nivel de prioridad, señales vitales y tiempo utilizado en la clasificación de riesgo.

          Resultados:

          confiabilidad moderada para elección de los diagramas de flujo y substancial para determinación de los discriminadores en los dos tipos de registro; substancial y moderada para prioridad, respectivamente, en el registro manual y electrónico. Para señales vitales, se presentó débil en el registro manual y substancial en el electrónico. La precisión presentó diferencia estadística significativa relacionada a las señales vitales. La media de tiempo utilizado con la clasificación de riesgo fue menor con la utilización del registro electrónico.

          Conclusión:

          el uso del registro electrónico presenta ventajas referentes a la confiabilidad, precisión y tiempo utilizado para la realización de la clasificación de riesgo, indicando la importancia de la adopción de tecnologías en el proceso de trabajo administrativo y asistencial en los servicios de salud.

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          Most cited references43

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          Interrater reliability: the kappa statistic

          The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.
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            The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument

            Background: COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) is an initiative of an international multidisciplinary team of researchers who aim to improve the selection of outcome measurement instruments both in research and in clinical practice by developing tools for selecting the most appropriate available instrument. Method: In this paper these tools are described, i.e. the COSMIN taxonomy and definition of measurement properties; the COSMIN checklist to evaluate the methodological quality of studies on measurement properties; a search filter for finding studies on measurement properties; a protocol for systematic reviews of outcome measurement instruments; a database of systematic reviews of outcome measurement instruments; and a guideline for selecting outcome measurement instruments for Core Outcome Sets in clinical trials. Currently, we are updating the COSMIN checklist, particularly the standards for content validity studies. Also new standards for studies using Item Response Theory methods will be developed. Additionally, in the future we want to develop standards for studies on the quality of non-patient reported outcome measures, such as clinician-reported outcomes and performance-based outcomes. Conclusions: In summary, we plea for more standardization in the use of outcome measurement instruments, for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended, and for stopping the use of poor outcome measurement instruments.
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              SQUIRE 2.0—Standards for Quality Improvement Reporting Excellence—Revised Publication Guidelines from a Detailed Consensus Process

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                Author and article information

                Journal
                Rev Lat Am Enfermagem
                Rev Lat Am Enfermagem
                rlae
                Revista Latino-Americana de Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
                0104-1169
                1518-8345
                05 December 2019
                2019
                : 27
                : e3241
                Affiliations
                [1 ]Universidade de São Paulo, Hospital Universitário, São Paulo, SP, Brazil.
                [2 ]Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
                Author notes
                Corresponding author: Emilia Aparecida Cicolo. E-mail: emiliacicolo@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-2301-378X
                http://orcid.org/0000-0002-8759-5670
                Article
                00409
                10.1590/1518-8345.3170.3241
                6896810
                31826170
                6cb866fe-ed92-4530-b5e7-fe4c42e7a263
                Copyright © 2019 Revista Latino-Americana de Enfermagem

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 October 2018
                : 23 September 2019
                Categories
                Original Article

                nursing,triage,decision support systems, clinical,computers,informatics,nursing informatics,enfermagem,triagem,sistemas de apoio a decisões clínicas,computadores,informática,informática em enfermagem,enfermería,triaje,sistemas de apoyo a decisiones clínicas,informática aplicada a la enfermería

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