Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process

Wolf, Lisa; Delao, Altair M.; Perhats, Cydne; Moon, Michael D.; Zavotsky, Kathleen Evanovich

doi:10.1016/j.jen.2017.06.010

Cited by 70 publications

(95 citation statements)

References 30 publications

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“…In a systematic review, Considine and colleagues reported that factual knowledge is more important in triage decisions than triage or emergency nursing experience [ 24 ]. Furthermore, the EMS nurse has mostly only one patient to consider at-the-scene, whereas the triage nurse in the ED may be influenced by the current situation and triage in order to solve logistical problems [ 25 ]. This suggests that context plays a role.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Magnusson

Herlitz

Axelsson

2020

Scand J Trauma Resusc Emerg Med

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Background In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse’s field assessment with the physician’s final hospital diagnosis. Methods A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse’s field assessment compared to hospital physician’s diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann–Whitney U test and Fisher’s exact test, and several binary classification tests were determined. Results Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse’s field assessment was appropriate in 84% of these cases. Conclusions In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse’s field assessment of time-sensitive conditions was appropriate in the majority of cases.

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Section: Discussionmentioning

confidence: 99%

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Magnusson

Herlitz

Axelsson

2020

Scand J Trauma Resusc Emerg Med

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“…The triage of patients in the Emergency Departments (ED) is a worldwide healthcare problem. Triage is commonly defined as an essential procedure in ED that involves sorting patients according to priorities [1], thereby reducing patients' military surgeons developed and implemented triage rules to promptly evaluate and categorize wounded soldiers [8]. The Emergency Departments around the world use different triage systems to assess the severity and urgency of incoming patients' conditions and to assign treatment.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and Practices of Triage Amongst Nurses Working in the Emergency Departments of Rural Hospitals in Limpopo Province

Phukubye¹,

Mbombi²,

Mothiba³

2019

TOPHJ

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Background: Many deaths in hospitals occur within 24 hours of admission. Some of these deaths could be prevented if the patients were effectively triaged, identified quickly, and treatment initiated without delay. Triage and emergency care have always been weak and under-emphasized components of healthcare systems in rural areas of Limpopo Province, and yet, if well organised, it could lead to saving many lives and reducing the ultimate costs of care. There have been few studies, and there is little information focusing on nurses’ knowledge about triage in rural hospitals. Objective: This study aims to assess the knowledge and practices of triage amongst nurses working in the Emergency Departments (ED) of the Sekhukhune District, Limpopo Province, South Africa. Methods: By employing a quantitative, non-experimental research method, 84 nurses working in the Emergency Departments, completed and submitted structured questionnaires. The validity and reliability were ensured by pre-testing the data collection instrument on respondents who were not part of the main study. Data were analyzed by using the SPSS version 25, Excel computer programs and score methods. Results: The findings indicate that there is a correlation between triage knowledge and job title (p-value = 0.046). Registered nurses, specialty nurses, and enrolled nurses, were found to know more than auxiliary nurses. However, the study discovered that, among the nurses with knowledge, 61% exercised poor triage practice, while only 30% showed evidence of good practice. Conclusion: The study aims at defining triage knowledge and practice amongst nurses in the Emergency Departments. The results indicate that nurses have knowledge regarding triage but have difficulty in converting their factual knowledge into practice, as they scored poorly on questions about the practice. In addition, there emerged a significantly positive relationship between triage knowledge and job titles. The study recommends the development of strategies to enhance the conversion of factual knowledge into practice regarding triage in the ED. This could be implemented through sustainable training courses regarding triage for all the categories of nurses.

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“…This is also demonstrated in other studies where the nurses describe how experience facilitates the assessments and makes them feel confident. 18 Depending on the informant who triaged the patients and what knowledge she possessed, assessments were different, which could result in patient safety being jeopardized. Hitchcock et al 19 confirm in their study that assessments varied depending on how much triage experience the nurse had.…”

Section: Discussionmentioning

confidence: 99%

Triage in primary healthcare

Göransson

Persson

Abelsson

2020

Nordic Journal of Nursing Research

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The majority of healthcare visits in Sweden are within the primary healthcare centres with a wide variety of patients, ranging from children to the elderly, varying from trivial to the most acute. The aim was to describe nurses’ experiences of triaging patients at walk-in clinics at primary healthcare centres. Semi-structured interviews with 12 nurses, analysed using qualitative analysis, were used. The overall understanding was that a physical meeting with the patient gave the opportunity for eye contact and physical examination of the patient’s body. With broad expertise and experience, the informants felt more confident in their assessment. Cooperation between colleagues meant always having someone to consult when the informants felt unsure. The result highlight that triage is a challenging and complex task for informants. In order to be able to triage in an effective way, the informant must possess broad competence through solid knowledge and experience.

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Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process

Cited by 70 publications

References 30 publications

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Knowledge and Practices of Triage Amongst Nurses Working in the Emergency Departments of Rural Hospitals in Limpopo Province

Triage in primary healthcare

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