Identifying Strategies for the Management of Interruptions for Novice Triage Nurses Using an Online Modified Delphi Method

Abstract

Purpose: To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions. Design: This study was based on the concepts of Benner's Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department. Methods and Analysis: A panel of nine triage, education, and operational management experts were selected based on their publication and presentation history. This panel participated in three Delphi rounds, providing individual responses during each round. All responses were entered into a RedCap database, which allowed research team members to synthesize the results and return summaries to the participants. Final consensus was reached among this panel regarding recommendations for successful strategies to address triage interruptions that can be encompassed in a training module. The experts were then asked to identify the best instructional modality for teaching each of the interruption management strategies. Findings: Eight strategies to mitigate the impact of interruptions were identified: (a) ensure nurses understand impact of interruptions; (b) ensure nurses understand consequences of interruptions on cognitive demands of healthcare workers that could influence behavior and lead to errors; (c) apologize to current patient before tending to interruption and give expectation of when you will return; (d) triage the interruption and decide to (i) ignore interruption, (ii) acknowledge, but delay servicing, interruption, or (iii) acknowledge and service interruption, delaying completion of interrupted task; (e) identify urgent communication as anything clinically significant that impacts the patient immediately or requires immediate intervention; (f) use focused questions to clarify whether interruption can wait; (g) redirect nonpriority interruptions; and (h) finish safety-critical task or tasks near completion before tending to an interruption. The Delphi participants recommended the best teaching modality was simulation for six of the strategies. Conclusions: Participants agreed that there are strategies that can be taught to novice triage nurses to mitigate the impact of interruptions. The experts in operations management, emergency nursing, and education agree that creating simulations to teach each of these strategies is an effective way to educate nurses. Clinical Relevance: Interruptions impact the quality of care provided to patients. Training nurses to prevent interruptions and mitigate the impact of interruptions when they occur has the potential to improve patient outcomes.

Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner’s theory

“…The results obtained from this research are similar to the results of the studies conducted by Aktash and Alamdar in 2017 and also by Al-Zahrani and Al-Mutri in 2022 [13,23]. Triage decision-making is an essential skill for nurses in all areas of patient care, to categorize patients according to their severity to manage patient flow [13,20]. Triage nurses should be able to make decisions quickly and efficiently [20].…”

“…Triage decision-making is an essential skill for nurses in all areas of patient care, to categorize patients according to their severity to manage patient flow [13,20]. Triage nurses should be able to make decisions quickly and efficiently [20]. In prioritizing the patient's urgency for an accurate classification and triage decision, the presence of expert and skilled emergency nurses is necessary to determine the best effect of the intervention on the patient's health [4,6].…”

“…The way information is interpreted and discussed varies between novices and experts. The difference in decision-making based on proficiency is that novice and advanced beginners do not consider different options and competent ones make a conscious assessment, while expert nurses make decisions based on their experiences so that there is no need for conscious analysis [20,21]. Expert nurses and appropriate triage decisions reduce waiting time and improve patient management, while unskilled personnel and incorrect triage decisions lead to waste of resources, delays in patient treatment, dissatisfaction, and adverse consequences [4,6].…”

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

“…Interruption is defined as any activity which requires the triage nurse to turn his or her attention away from the patient being triaged or any activity that causes the nurse to leave the triage area (Johnson et al, 2014). Triage interruptions lead to incorrect triage decisions, missed symptom identification, incomplete assessment or unasked questions, and can potentially delay care, resulting in significant morbidity or mortality (Kwon et al, 2021) and are caused mostly by other healthcare workers, paramedics, phone calls, patients and relatives (Andersson et al, 2006;Johnson et al, 2014Johnson et al, , 2021. At the time of occurrence, triage nurses need to be able quickly and efficiently to determine whether an interruption is critical enough to take precedence over the current task being performed (Johnson et al, 2021).…”

Exploring the turbulent nature of nurses’ workflow

“…Through proactive understanding of known tasks with the potential to interrupt, nurses can learn to organize their work to minimize disruptions. Johnson et al, (2021) proposed strategies that can be taught to mitigate interruptions such as understanding the nature and consequences of interruptions, triaging interruptions prior to deciding how to manage them, and prioritizing safety-critical tasks while redirecting low priority interruptions.…”