Factors contributing to patient safety during triage process in the emergency department: A systematic review

Abstract

BackgroundTriage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety.ObjectivesTo identify and examine the factors contributing to patient safety during the triage process.MethodsA systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria.ResultsOut of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule.ConclusionsThis review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients.Relevance to Clinical PracticeThis review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety.Patient or Public ContributionNo patient or public contribution was required to design or undertake this review.

Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating reflexive thematic analysis.

“…The staff have repeatedly mentioned triage should be for triaging patients only as they shared their concerns on the unstable patients in the long triage cues 14,27,28 .…”

“…Early point of care testing at triage has been shown to reduce ED length of stay (EDLOS) 13 . However this may come at a cost as it redirects the focus of triage staff from their primary role; which is to triage patients 14 . Most recently, virtual care has the potential to divert patients from visiting an ED [15][16][17][18] .…”

Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study

“…Several factors within the realm of emergency care significantly impact the efficacy of the triage process. These factors encompass resource management and patient flow, patient satisfaction, the expertise and acumen of triage nurses, and the safety culture within the organisation [9].…”

Analysis of Factors Related to The Accuracy of Triage Assessment at The Emergency Room

“…and Circulation (C) disturbances and triage is also carried out to assess the presence or absence of aspects of patient virulence levels that can be assessed by looking at the presence or absence of Early Wearning System (EWS) Covid-19 Screening indicators (Fekonja et al, 2023;Reay et al, 2020;Yancey & O'Rourke, 2023) So that the knowledge of a nurse in handling patient responses in the emergency room is very necessary (Molina-Mula & Gallo-Estrada, 2020) There are a number of triage allagrhythms based on the level of urgency assumed by the triage nurse. An effective triage process can improve efficiency in the emergency department which can directly affect length of stay, outcomes, and even patient satisfaction (AlSerkal et al, 2020;Savioli et al, 2023).…”