From pen-and-paper questionnaire to a computer-assisted instrument for self-triage in the ophthalmic emergency department: Process and validation

Eva S van Eijk, Marijke Wefers Bettink-Remeijer, Reinier Timman, Jan J V Busschbach

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND/AIMS: The ISET (Instrument for SElf-Triage) is a validated pen-and-paper instrument for patient self-triage in ophthalmic emergency departments. The aim of the present study is to develop a validated computer-assisted ISET (ca-ISET) with a touch screen.

METHODS: In the emergency department of the Eye Hospital Rotterdam, the Netherlands, successive computer-assisted versions of the ISET were tested by patients visiting the emergency department. The versions were developed by iteratively prototyping, testing, analysing and refining the computer-assisted ISET. In three test cycles, 16, 53 and 75 patients ≥ 18 years old, visiting the emergency department for the first time with their ophthalmic complaint, were monitored while using the ca-ISET. They were debriefed, and their input was used to adapt the computer-assisted ISET. To validate the ca-ISET, a sensitivity outcome of .80 and a specificity of .70 was required (CI=95%). The ca-ISET sensitivity and specificity were tested by comparing ca-ISET triage outcome to triage outcome as decided by the regular triage assistant.

RESULTS: ISET accuracy increased from 0.69 in the first test to 0.79 in the third test. Sensitivity increased from 0.66 (CI 0.13-0.98) to 0.80 (0.51-0.95). Specificity increased from 0.69 (0.39-0.90) to 0.78 (0.65-0.88). To improve validity and usability, several adjustments were made in the text and the flow chart of the computer-assisted ISET.

CONCLUSIONS: A ca-ISET prototype was developed, with minor textual modification of the pen-and-paper version. The new ca-ISET was validated by comparing against triage decided by the regular triage assistant.

Original languageEnglish
Pages (from-to)258-62
Number of pages5
JournalComputers in Biology and Medicine
Volume66
DOIs
Publication statusPublished - 1 Nov 2015

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Decision Support Systems, Clinical
  • Decision Trees
  • Emergency Service, Hospital
  • Eye Injuries/diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Patient Participation
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Software
  • Surveys and Questionnaires
  • Triage
  • User-Computer Interface
  • Young Adult

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