Evaluation of nurse triage in a British accident and emergency department.

Abstract

Objective-To compare formal nurse triage with an informal prioritisation process for waiting times and patient satisfaction.Setting-Accident and emergency department of a district general hospital in the midlands in 1990.Design-Patients attending between 800 am and 900 pm over six weeks were grouped for analysis according to whether triage was operating at time of presentation and by their degree of urgency as assessed retrospectively by an accident and emergency consultant.Patients -5954 patients presenting over six weeks. Main outcome measures-Time waited between first attendance in the department and obtaining medical attention, and patient satisfaction measured by questionnaire.Results-Complete data on waiting time were collected on 5037 patients (85%). Only 1213 of the 2515 (48%) patients presenting during the triage period were seen by a triage nurse. Patients in the triage group waited longer than those in the no triage group in all four retrospective priority categories, though differences were significant for only the two most urgent categories (difference in median waiting time 10-5 (95% confidence interval 3 5 to 14) min for category 1 and 8-5 (3 to 12) min for category 2). Responses to the patient satisfaction questionnaire were similar in the two groups except for the question relating to anxiety relating to pain.Conclusions-This study fails to show the benefits claimed for formal nurse triage. Nurse triage may impose additional delay for patient treatment, particularly among patients needing the most urgent attention.

A review of factors affecting patient satisfaction with nurse led triage in emergency departments

“…Similarly, Cooper et al (2002) compared satisfaction among patients triaged by a Senior House Officer (SHO) with those triaged by ED nurses. Only three studies used random sampling methods to select participants (Chan & Chau, 2005;Chang et al, 1999;Cooper et al, 2002), while in the rest of the included studies the sample was chosen conveniently (Bruce et al, 1998;Davis & Duffy, 1999;Dinh et al, 2012a;Elder et al2004;George et al, 1992;Goransson & Rosen, 2010;Jennings et al, 2009;Mabrook & Dale, 1998;Moser et al, 2004;Rhee & Dermyer, 1995;Thrasher & Purc-Stephenson, 2008;Wilson & Shifaza, 2008). The sample selection strategy was not mentioned in three studies (Barr et al, 2000;Byrne et al, 2000;Topacoglu et al, 2004).…”

“…Five studies compared two groups. For instance, George et al (1992) compared patients' satisfaction between a nurse triaged and non-nurse triaged group. Chang et al (1999) and Dinh, et al, (2012a) compared satisfaction rates between patients who were triaged by ED nurses with those triaged by doctors.…”

“…Six studies examined patient satisfaction in relation to services provided in the ED and explored patient satisfaction with nurse-led-triage as one aspect of the study (Bruce et al, 1998;Dinh et al, 2012a;George et al, 1992;Jennings et al, 2009;Topacoglu et al, 2004).…”

“…Table 2 summarises the characteristics of included studies. The sample size ranged from 28 (Bruce et al, 1998) to 707 participants (George et al, 1992) attending the ED. Five studies compared two groups.…”

A study of the effect of introduction of JTAS in the emergency room

“…However, after introduction of JTAS, when compared to the previous simple triage system, the decrease in the frequency of sudden turn for the worse was unknown. According to previous reports, TBAEC in cases of myocardial infarction improved after the introduction of systematic triage,1 TBAMA improved after the introduction of JTAS,15 and TBAMA worsened after the introduction of systematic triage 16, 17. So, in standard emergency rooms where nursing staff is chronically lacking, there is a doubtful point whether sufficient effect for the same labor has been obtained after the introduction of JTAS.…”