{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:03:29Z","timestamp":1760123009655,"version":"3.41.2"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Innovative Project of Children's Research Institute, Guangzhou Women and Children's Medical Center, China","award":["IP-2018-006","Pre-NSFC-2018-004","Pre-NSFC-2018-008"],"award-info":[{"award-number":["IP-2018-006","Pre-NSFC-2018-004","Pre-NSFC-2018-008"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Specialist Pediatric Nursing"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Because the quality of medical resources is extremely uneven across China, it is nearly impossible to implement a unified emergency triage program. The aim of the study is to examine triage using the \u201ctwo\u2010step four\u2010level<jats:sup>+<\/jats:sup>\u201d triage model in a hospital in Southern China, with an emphasis on hand, foot, and mouth disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>This was a retrospective study of all patients seen in the pediatric emergency room (ER) between January 1, 2012 and December 31, 2018, at the Guangzhou Women and Children's Medical Center. The \u201ctwo\u2010step and four\u2010level<jats:sup>+<\/jats:sup>\u201d was manually implemented in 2012, and an electronic triage system was developed and applied since 2015. Emergency quality control indicators were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 645,473 patients triaged at the pediatric ER between January 1, 2015 and December 31, 2018. After the first step, 17,444 patients were classified as unstable, including 6546 (1.01%) Level I patients, 10,898 (1.69%) Level II patients, 210,368 (32.5%) Level III patients, and 417,661 (64.8%) Level IV patients. After triage implementation, the stay time of the patient in the pediatric ER decreased each year (all <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) and shortened to 20.3\u2009\u00b1\u20092.2\u2009h in 2018. Compared with 2012\u20132014, the mortality of 2015\u20132018 decreased by 21.1%, the rate of unexpected resuscitation was 0%, and the complaints of overcrowding decreased (all <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Practice Implications<\/jats:title><jats:p>This \u201ctwo\u2010step four\u2010level<jats:sup>+<\/jats:sup>\u201d triage method can improve the medical care quality of pediatric ER in China.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jspn.12305","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T17:27:39Z","timestamp":1595525259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The \u201ctwo\u2010step four\u2010level<sup>+<\/sup>\u201d pediatric triage method in a medical center in Southern China"],"prefix":"10.1111","volume":"25","author":[{"given":"Xian","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinxia","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiechan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2434-0336","authenticated-orcid":false,"given":"Peiqing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2003.302"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.09.010"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-227X-11-11"},{"issue":"3","key":"e_1_2_11_5_1","first-page":"507","article-title":"CAEP issues. 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