Understanding nurses perspectives of acuity in the process of emergency mental health triage: a qualitative study

Abstract

Background: Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim: To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods: An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings: Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion: Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.

Evaluation of the effectiveness of the Australian Mental Health Triage Scale in the emergency department: The case of Turkey

“…These situations can lead to the patients being stigmatized, having a prolonged hospital stay, and a delay in treatment (Karman et al, 2015). Also, for employees, the risks related to employee safety increase and job satisfaction and efficiency decrease, treatment costs increase and low‐quality service occurs when looking at the institutional setup (Broadbent et al, 2020; Downey et al, 2015a; Ramadan, 2016).…”

“…The approach was first implemented with a mental health triage scale which is developed in Australia. In particular, The Australian Mental Health Triage Scale (AMHTS) developed and used as a guide by Broadbent et al (2002 ), Smart et al (1999 ), proven to reliable among referees (Broadbent et al, 2020; Mental Health Triage, Health Policy Priorities Principal Committee, 2011) and has high sensitivity in the evaluation of patients with mental problems (Broadbent et al, 2020; Downey et al, 2015a). The main goal of the AMHTS is not to increase or decrease patient waiting times, but to determine the waiting times of priority patients and to make the waiting times of these patients more appropriate to their needs (Sands et al, 2014).…”

“…Therefore, emergency personnel need to have the knowledge and skills to evaluate the patients physiologically and psychosocially, to provide appropriate treatment and care, to foresee possible risk, to create a safe environment, and to appropriately manage crises (Büyükbayram & Engin, 2018). However, difficulties arise from emergency staff harboring negative attitudes toward patients (Chou & Tseng, 2020), lack of knowledge and skills (Broadbent et al, 2020; Chou & Tseng, 2020; Ryan et al, 2021), physical conditions in the emergency department (Liddicoat et al, 2020; Ryan et al, 2021) and systematic problems in emergency department functioning (Büyükbayram & Engin, 2018; Mackway‐Jones & Mackway‐Jones, 2020). These situations can lead to the patients being stigmatized, having a prolonged hospital stay, and a delay in treatment (Karman et al, 2015).…”

“…However, the CCTAS does not have a detailed field for evaluating patients with mental problems. Many studies have reported that triage scales for general patients are insufficient in evaluating emergency psychiatric applications (Broadbent et al, 2020; Smart et al, 1999). To improve the quality of emergency psychiatric care in Turkey, this study examines the effectiveness of the AMHTS and evaluates its reliability and validity.…”

“…The main goal of the AMHTS is not to increase or decrease patient waiting times, but to determine the waiting times of priority patients and to make the waiting times of these patients more appropriate to their needs (Sands et al, 2014). It helps nurses (and other professionals) to understand the patient's condition better and to link the patient to appropriate treatment sooner so that the patient recovers faster (Broadbent et al, 2020;Smart et al, 1999).…”