This study evaluated the agreement and classification performance of ChatGPT-5-generated triage compared with nurse triage using an expert reference decision in adult emergency department patients. In this retrospective cross-sectional study, 1564 adult patients with documented yellow or green triage classifications were included. Standardized triage-level patient information was entered into ChatGPT-5 using an identical prompt for all patients. Agreement was assessed using Cohen's κ, and classification performance was evaluated using sensitivity, specificity, and overall accuracy. The mean age was 39.8 ± 18.5 years, and 55.9% of patients were female. The expert reference decision classified 50.0% of patients as yellow, compared with 48.5% by ChatGPT-5-generated triage and 25.6% by nurse triage. ChatGPT-5-generated triage showed higher agreement with the expert reference decision than nurse triage (κ = 0.670 vs. 0.467), higher overall accuracy (83.5% vs. 73.3%), and higher sensitivity (82.0% vs. 49.0%). Compared with nurse triage, ChatGPT-5-generated triage produced fewer green classifications among expert-reference yellow patients (18.0% vs. 51.0%), whereas nurse triage produced fewer yellow classifications among expert-reference green patients (2.3% vs. 15.0%). These findings indicate that ChatGPT-5-generated triage more closely approximated the expert reference decision than nurse triage under the conditions evaluated in this study.
Objective To investigate the effectiveness of Healthcare Failure Mode and Effect Analysis (HFMEA) in optimizing the emergency management workflow for Acute Myocardial Infarction (AMI) and to assess its impact on emergency efficiency, clinical outcomes, and patient satisfaction. Methods AMI patients treated at our hospital during different periods were enrolled and divided into two groups: a control group receiving conventional emergency procedures and a post-optimization group managed with an HFMEA-optimized emergency workflow. The HFMEA implementation involved forming a multidisciplinary team, constructing an integrated prehospital-to-in-hospital treatment process map, identifying high-risk failure modes based on the Risk Priority Number (RPN), developing targeted improvement measures, and establishing an information-based quality monitoring system. Outcome measures included key emergency time intervals, clinical outcomes, and healthcare quality indicators. Results Following HFMEA implementation, the post-optimization group showed significant reductions in all key emergency time metrics compared with the control group, including triage time, time to first electrocardiogram, Door-to-Catheterization (D-to-C) time, and Door-to-Balloon (D-to-B) time (all P < 0.001), and the effect sizes for all major time-related indicators between the two groups reached the large-effect level (Cohen's d ≥ 0.8, r ≥ 0.5). The total incidence of adverse events was significantly lower in the post-optimization group (P < 0.05), while rescue success rates did not differ significantly between groups (P > 0.05). Regarding healthcare quality, patients in the post-optimization group had shorter hospital stays and higher satisfaction scores as measured by a dedicated survey instrument (both P < 0.05). Conclusion HFMEA effectively identifies high-risk steps within the AMI emergency workflow. Targeted process optimization can significantly enhance emergency efficiency, reduce adverse events, improve healthcare quality, and optimize patient experience.
Background Emergency nurses play a critical role in identifying and managing domestic violence (DV); however, gaps remain in their preparedness and clinical responses.Aim: To examine recognition, response, institutional support, and educational needs among emergency nurses in South Korea, and to explore differences in DV-related measures according to personal DV exposure. Methods A cross-sectional survey was conducted among 313 emergency nurses in South Korea using a questionnaire developed through literature review. Data were analyzed using descriptive statistics, independent t-tests, chi-square tests, and Holm adjustment. Results Although 75.7% considered screening appropriate when DV was suspected, 41.5% had ever conducted screening. Among nurses with experience in DV care, 16.2% and 12.5% reported evidence collection/preservation and direct reporting to law enforcement, respectively. Institutional DV protocols were available to 42.5%. Only 25.2% had received DV education, whereas 94.2% perceived further education as necessary. Nurses who witnessed DV among family members reported lower perceived reporting barriers (Holm-adjusted p < .001). Conclusion DV screening was widely considered appropriate when DV was suspected, whereas screening experience, specialized forensic practices, and institutional support were limited, and the perceived need for further DV education was high. Future studies should evaluate interventions combining DV education with institutional support.
Introduction Remimazolam is a novel ultra-short acting benzodiazepine with a fast onset and short half-life, with similar safety profile as other sedatives such as midazolam or propofol. This study evaluated the safety of using remimazolam for procedural sedation in the emergency department (ED) by nurses without previous anesthesiologic specialization, who were experienced in airway management and trained to use remimazolam. Methods This prospective observational study was performed at the ED at Aalborg University Hospital between September 2024 and May 2025. Inclusion criteria were: patients needing sedation for a procedure, age > 12 years, ASA score 1–3, and an available nurse who had received thorough education in remimazolam, but having no anesthesiologic specialization. Safety was assessed using a three-level severity scale: 1 = no adverse event, 2 = mild/moderate adverse event, and 3 = severe adverse event. The results are presented as the percentage of patients within each category. Results A total of 183 patients were included, and 89% underwent procedural RM sedation without respiratory adverse effects, 7.5% experienced mild/moderate adverse effects, and 2.2% experienced severe respiratory complications. All complications were resolved in the ED within minutes. The majority of patients (94%) experienced amnesia for the procedure. Procedures could be started at a mean of 3 (IQR: 2–4) minutes after administration of remimazolam. Patients could safely be left unsupervised within 15 (IQR 12;20) minutes of the first remimazolam dose. Conclusion Severe respiratory adverse effects were rare, and remimazolam was safe to use in the ED by nurses without anesthesiologic specialization. Most patients had amnesia and/or were satisfied with the sedation. Procedures could be initiated within minutes and resolved successfully in most cases.
PURPOSE:Emergency department handovers are vital for patient safety. However, factors influencing nurses' clinical decision-making ability in inbound handovers remain insufficiently understood. We aimed to construct a hypothetical model of factors influencing clinical decision-making ability and handover evaluation among emergency department nurses for inbound patients in the emergency department. METHOD:Structural equation modelling was utilised to verify the goodness-of-fit of the model and the significance of the paths. Data were collected from 223 emergency department nurses using a structured web-based self-report survey conducted from 28 to 29 August 2023. Confirmatory factor analysis and structural equation modelling were performed. RESULTS:The final model showed an improved fit compared with the initial model. Clinical decision-making ability was directly influenced by knowledge-sharing behaviour, autonomy, and critical thinking disposition, and indirectly by work complexity, nursing work environment, knowledge-sharing behaviour, and autonomy. Handover evaluation was directly influenced by nursing work environment, knowledge-sharing behaviour, and clinical decision-making ability, with indirect effects from work complexity, nursing work environment, knowledge-sharing behaviour, and critical thinking disposition. CONCLUSION:We established a structural model that provides a foundation for educational programmes and interventions to enhance emergency department nurses' clinical decision-making and handover performance.
