Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction

BackgroundThe objective of this study was to explore factors associated with the triage category assigned by the triage nurse for patients ultimately diagnosed with acute myocardial infarction.MethodsThis was a retrospective analysis of 12 months of data, on adult emergency department patients ultimately diagnosed with acute myocardial infarction. Data were obtained from hospital databases and included patient demographics, patient clinical characteristics and nurses’ experience.ResultsOf the 153 patients, 20% (95% CI: 14–27%) were given a lower urgency triage category than recommended by international guidelines. Compared to patients who were triaged Australasian Triage Category 1 or 2, patients with an Australasian Triage Category 3–5 were older (mean age 76 versus 68 years), more likely to be female (63% versus 32%), more likely to present without chest pain (93% versus 35%) and less likely to have a cardiac history (3.3% versus 17.9%). A slightly higher proportion of patients Australasian Triage Category 3–5 were triaged by an experienced nurse (50%) compared to patients categorised Australasian Triage Category 1–2 (35.2%) but this finding did not reach statistical significance.ConclusionsOne in five presentations was given a lower urgency triage category than recommended by international guidelines, potentially leading to delays in medical treatment. The absence of chest pain was the defining characteristic in this group of patients, along with other factors identified by previous research such as being of female sex and elderly.     

Facilitators and Barriers of the Triage Process based on Emergency Nurses’ Experience with the Korean Triage and Acuity Scale: A Qualitative Content Analysis

PurposeSince 2016, the Korean Triage and Acuity Scale (KTAS) algorithm has been applied to the triage process in the emergency departments (EDs) of Korea. This study aimed to investigate the facilitators of and barriers to a well-run triage function based on how Korean emergency nurses perceived the triage process and their experiences with it.MethodsData were collected using focus group interviews from June 2018 to January 2019. Twenty emergency nurses were divided into two junior and four senior groups based on their level of clinical experience. All interviews were recorded as they were spoken and transcribed. Data were analyzed using qualitative content analysis.ResultsThe participants recognized the need for the KTAS algorithm to efficiently classify emergency patients and were working on it properly. According to the data, we extracted 4 themes and 20 subthemes. Four themes were as follows: (1) awareness about the necessity of triage, (2) facilitators to triage process, (3) barriers to triage process, and (4) suggestions for the establishment and development of triage.ConclusionFrom the findings of this study, various vulnerabilities of the triage process were identified, and solutions were suggested from the emergency nurses’ perspective. Educational, staffing, financial support, and periodic updates of the KTAS are needed to promote the triage process in the future.     

Emergency nurses’ knowledge and experience with the triage process in Hunan Province,China

IntroductionTriage is implemented to facilitate timely and appropriate treatment of patients, and is typically conducted by senior nurses. Triage accuracy and consistency across emergency departments remain a problem in mainland China. This study aimed to investigate the current status of triage practice and knowledge among emergency nurses in Changsha, Hunan Province, China.MethodA sample of 300 emergency nurses was selected from 13 tertiary hospitals in Changsha and a total of 193 completed surveys were returned (response rate = 64.3%). Surveys were circulated to head nurses, who then distributed them to nurses who met the selection criteria. Nurses were asked to complete the surveys and return them via dedicated survey return boxes that were placed in discreet locations to ensure anonymity.ResultsJust over half (50.8%) of participants reported receiving dedicated triage training, which was provided by their employer (38.6%), an education organisation (30.7%) or at a conference (26.1%). Approximately half (53.2%) reported using formal triage scales, which were predominantly 4-tier (43%) or 5-tier (34%).ConclusionsThe findings highlight variability in triage practices and training of emergency nurses in Changsha. This has implications for the comparability of triage data and transferability of triage skills across hospitals.     

The Relationship Between Mindfulness,Triage Accuracy,and Patient Satisfaction in the Emergency Department: A Moderation-Mediation Model

IntroductionIndividual and collective mindfulness attracts growing research attention, yet reports of their impact on health care professionals’ work behaviors are scarce, especially in the emergency department. The aim of the current study was to explore whether the association between trait mindfulness and triage accuracy is moderated by the emergency workload environment, and whether this association promotes patient satisfaction subject to levels of collective mindfulness.MethodsA prospective consecutive nested design was conducted. Data were collected from ED teams (nurses and physicians, N = 96) on individual characteristics and trait mindfulness. Data were also collected on triage accuracy, triage team characteristics, collective mindfulness, workload, and patient satisfaction (N = 960) at a specific patient–ED team encounter.ResultsFindings indicated that ED workload environment (b = 0.24, P < 0.01), trait mindfulness (b = 1.80, P < 0.01), and their interaction (b = −0.04, P < 0.05) were associated with triage accuracy. Triage accuracy (b = 1.81, P < 0.001), collective mindfulness (b = 1.29, P < 0.001), and their interaction (b = −0.32, P < 0.001) were associated with patient satisfaction. The moderated-mediation model was significant under high, but not under extreme, levels of ED workload environment and all levels of collective mindfulness.DiscussionTrait and collective mindfulness are relevant to ED triage and patient satisfaction, but their effects are bounded by workload. The beneficial gain of nurses’ trait mindfulness on triage accuracy and collective mindfulness on patient satisfaction is demonstrated only under high-workload environments but limited under extreme-workload environments.     

情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响

目的探讨情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响。方法采用整群便利抽样法,选取2017年6月至2019年6月本院急诊科低年资护士25名作为研究对象。将情景模拟训练方法引入护士急救培训工作中,比较培训前后护士急救事件岗位胜任能力得分、护士急救技能得分。结果在模拟训练6个月后急诊护士专业知识、专业技术、专业能力及个人综合素质评分均显著高于训练前(P<0.05);CPR、插管配合、洗胃、吸痰、静脉穿刺及电除颤技能评分均显著高于训练前(P<0.05);综合操作时间短于培训前(P<0.05)。结论情景模拟训练应用于低年资急诊分诊护士中,可以显著提高低年资急诊护士的岗位胜任能力和急救技能水平,对提高医院急救成功率及护理水平均具有重要意义。     

Triage in the emergency department--a qualitative study of the factors which nurses consider when making decisions

Triage, as a concept, is relatively new in Sweden and means 'sorting'. The triage process was developed to grade patients who needed immediate care. Triage is currently important for the emergency treatment system, and nurses are expected to work with it professionally. The aim of this study is to describe how nurses implement triage when patients arrive at the emergency department of a county hospital, situated in a rural area of Sweden, as well as to highlight the factors considered when prioritizing, in connection with nurses' decision-making. The method used was observations of 19 nurses, with minimal disturbance in their triage work, followed by a short tape-recorded interview, during which the nurses were asked to reflect upon their decision of priorities. Qualitative content analysis of data has been used. The results were divided into two areas, internal factors and external factors. The internal factors reflect the nurse skills and personal capacity. The external factors reflect work environment, including high workload and practical arrangements, and should always be perceived and taken into consideration. Using these factors as a basis, the patients' clinical condition, clinical history, various examinations and tests form an assessment, which subsequently results in a prioritization.     

Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey

IntroductionThe quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making.MethodA total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form.ResultPrior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability.ConclusionEmergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.     

Patient experience of the triage encounter in a Swedish emergency department

Emergency department triage is a prerequisite for the rapid identification of critically ill patients and for allocation of the correct acuity level which is pivotal for medical safety. The patient’s first encounter with a medical professional in the emergency department is often with the triage nurse.ObjectivesTo identify patient experience of the triage encounter.MethodsA questionnaire focusing on the patient–triage nurse relationship in terms of satisfaction with the medical and administrative information, privacy and confidentiality in the triage area as well as triage nurse competence and attitude was answered by 146 participating patients.ResultsThe majority of patients perceived that while they were triaged immediately upon arrival to the emergency department, they were often given limited information about the waiting time. Although almost a quarter of the patients did not wish to have information about their medical condition from the triage nurse, 97% of the patients considered the triage nurse to be medically competent for the triage task.ConclusionsPatients were generally satisfied with the reception and care given by the triage nurses, but less satisfied about information about expected waiting time. We suggest therefore, that patients should be routinely informed about their estimated waiting time to be seen by the doctor in addition to their triage level.     

Doctor at triage – Effect on waiting time and patient satisfaction in a Jamaican hospital

IntroductionWaiting time in the Emergency Departments is a major source of patient dissatisfaction in hospitals. Triage attempts to have the most critically ill patients seen first with an overall reduction in waiting time. Triage teams may include specially trained nurses or alternatively a specialist physician. The aim of this study was to determine if inclusion of a specialist physician on the triage team at the University Hospital of the West Indies (UHWI) in Kingston Jamaica reduced waiting time and improved patient satisfaction.MethodsA prospective, cross sectional survey of ambulatory care patients was undertaken in 2006. Triage was completed by a team consisting of a doctor and two nurses during the first week and by nurses only during the second week.ResultsThe study showed that there was no significant difference in the length of time patients spent in the emergency department based on whether or not they were triaged by a physician led team or by a team of nurses only. Type of triage team did not affect the level of patient satisfaction. Waiting time was significantly influenced by factors which came into play after triage such as the wait for X-ray and laboratory services.ConclusionsThere appears to be no reduction in waiting times experienced by patients at the UHWI emergency department as a result of inclusion of a specialist emergency physician in the triage process. This suggests that specialist emergency department nurses are adequately trained in triage, and that delays in the triage process at UHWI are due to other factors.     

Improving ED Emergency Severity Index Acuity Assignment Using Machine Learning and Clinical Natural Language Processing

IntroductionTriage is critical to mitigating the effect of increased volume by determining patient acuity, need for resources, and establishing acuity-based patient prioritization. The purpose of this retrospective study was to determine whether historical EHR data can be used with clinical natural language processing and machine learning algorithms (KATE) to produce accurate ESI predictive models.MethodsThe KATE triage model was developed using 166,175 patient encounters from two participating hospitals. The model was tested against a random sample of encounters that were correctly assigned an acuity by study clinicians using the Emergency Severity Index (ESI) standard as a guide.ResultsAt the study sites, KATE predicted accurate ESI acuity assignments 75.7% of the time compared with nurses (59.8%) and the average of individual study clinicians (75.3%). KATE’s accuracy was 26.9% higher than the average nurse accuracy (P <.001). On the boundary between ESI 2 and ESI 3 acuity assignments, which relates to the risk of decompensation, KATE’s accuracy was 93.2% higher, with 80% accuracy compared with triage nurses 41.4% accuracy (P <.001).DiscussionKATE provides a triage acuity assignment more accurate than the triage nurses in this study sample. KATE operates independently of contextual factors, unaffected by the external pressures that can cause under triage and may mitigate biases that can negatively affect triage accuracy. Future research should focus on the impact of KATE providing feedback to triage nurses in real time, on mortality and morbidity, ED throughput, resource optimization, and nursing outcomes.     

首因效应提高患者对急诊科检诊分诊护士满意率探索

目的：探讨首因效应提高急诊患者对检诊分诊护士满意率的效果。方法：2013-01-2013-02急诊科对分诊检诊护士实施首因效应培训,采用自制调查表和本院分诊护士绩效考核表,对比分析2013-03-2013-05和2012-03-2012-05,急诊分诊检诊护士在实施前后分诊准确率、患者满意率、患者投诉率和绩效考核成绩。结果：实施首因效应实施前后分诊准确率、患者满意率、分诊护士投诉率和分诊护士绩效考核成绩比较,差异有统计学意义（P〈0.05）。结论：首因效应可以显著提高急诊护士分诊准确率、急诊患者对检诊分诊护士的满意率,提高绩效考核成绩,同时降低患者的投诉率。     

Triage education in rural remote settings: A scoping review

BackgroundTriage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings.MethodA scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases.Results6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included ‘variability of triage accuracy and assessment’; ‘education qualifications and experience’; and ‘training and supervision’.ConclusionThis review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.