Effect of problem-based learning on severity classification agreement by triage nurses

Abstract

Background Differences in the classification results among triage nurses in the emergency room can be improved by training or applying an algorithm. This study aimed to confirm whether the agreement among triage nurses could be improved through learner-led problem-based learning. Methods This study had a single-group time series design to investigate the effect of problem-based learning led by triage nurses on the agreement of Korean Triage and Acuity Scale classification results for patients who visited the emergency department. We extracted 300 patients each in May and August 2018 before learning began and 300 patients each in May and August 2019 after learning. Results After problem-based learning was applied, the self-efficacy of triage nurses for emergency patient classification increased statistically significantly compared to before learning (7.88 ± 0.96, p < .001), and the weighted kappa coefficient was also found to be almost perfectly agreement (0.835, p < .001). Conclusions In this study, problem-based learning improved the inter-rater agreement of Korean Triage and Acuity Scale classification results and self-efficacy of triage nurses. Therefore, problem-based learning can contribute to patient safety in the emergency department by enhancing the expertise of triage nurses and increasing the accuracy of triage classification.

Evaluation and Enhancement of Triaging Services Through Quality Improvement Tools at Primary Health Care Level: A Clinical Audit Study

“…To identify patients who do not need earlier intervention and to make the best use of emergency medical resources for prompt treatment, accurate patient categorization is crucial. 7 Our baseline audit had shown emergency case triage categorization had a suboptimal level of (63%) compliance, and it was observed that hardly in 48% of emergency situations the Physicians had attended the patients within the recommended 5 min. Studies showed that by correctly categorizing emergencies cases based on an accurate initial assessment of patients who attend the triage clinic, the length of time spent there can be decreased.…”

“…8 Problem-based learning can improve the knowledge of triage nurses and boost the precision of triage categorization, which can subsequently improve the safety of the patient in the treatment room. 7 Even though only 74% of patients were attended by the physicians within 90 min for priority cases, the categorization of triage priority cases showed 91% compliance. When routine cases were correctly categorized and all patients were physically seen during the same shift, it was determined that 100% compliance was the best level of compliance.…”

“…Studies showed that by correctly categorizing emergencies cases based on an accurate initial assessment of patients who attend the triage clinic, the length of time spent there can be decreased. 7 Therefore, triage nurses in charge of initial assessment in the triage clinics should classify the severity of patients arriving quickly and accurately, which is deemed to be their primary role. 8 Problem-based learning can improve the knowledge of triage nurses and boost the precision of triage categorization, which can subsequently improve the safety of the patient in the treatment room.…”

“…A similar study was conducted in Korea to confirm whether the triage categorization agreement among triage nurses could be improved through problem-based training and concluded that problem-based learning can improve the knowledge of triage nurses and improve the precision of triage classification, which subsequently improves the patient safety in the emergency room. 7 …”