Triage in Australian emergency departments: Results of a New South Wales survey

Machine Learning Model Reveals Determinators for Admission to Acute Mental Health Wards From Emergency Department Presentations

This research addresses the critical issue of identifying factors contributing to admissions to acute mental health (MH) wards for individuals presenting to the emergency department (ED) with MH concerns as their primary issue, notably suicidality. This study aims to leverage machine learning (ML) models to assess the likelihood of admission to acute MH wards for this vulnerable population. Data collection for this study used existing ED data from 1 January 2016 to 31 December 2021. Data selection was based on specific criteria related to the presenting problem. Analysis was conducted using Python and the Interpretable Machine Learning (InterpretML) machine learning library. InterpretML calculates overall importance based on the mean absolute score, which was used to measure the impact of each feature on admission. A person's 'Age' and 'Triage category' are ranked significantly higher than 'Facility identifier', 'Presenting problem' and 'Active Client'. The contribution of other presentation features on admission shows a minimal effect. Aligning the models closely with service delivery will help services understand their service users and provide insight into financial and clinical variations. Suicidal ideation negatively correlates to admission yet represents the largest number of presentations. The nurse's role at triage is a critical factor in assessing the needs of the presenting individual. The gap that emerges in this context is significant; MH triage requires a complex understanding of MH and presents a significant challenge in the ED. Further research is required to explore the role that ML can provide in assisting clinicians in assessment.

Emergency triage nurses' perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study

BACKGROUND

Triage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome.

OBJECTIVE

To describe triage nurses' perceptions on caring behaviors and patient safety in the triage area.

DESIGN

Strauss and Corbin's Grounded theory method was used to develop the model.

METHODS

The study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin's coding framework.

RESULTS

The analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category "Triage caring", four subcategories were developed: (1) Assurance of triage nurses' presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety.

CONCLUSIONS

The triage nurses' perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient's safety at the same time.

IMPLICATIONS FOR THE NURSING FIELD

A better understanding of the importance of triage nurses' caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients' needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety.

NO PATIENT OR PUBLIC CONTRIBUTION

The study's design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.

Understanding the demographics, training experiences and decision-making practices of UK triage nurses

BACKGROUND

International research suggests that triage nurses' decision-making practices and training experiences vary significantly across emergency departments (EDs). However, there does not appear to be similar research published in the UK. Understanding factors, such as demographics, training and decision-making could provide a picture of triage nurses working in UK EDs, identify the interventions required to improve practice and inform further research.

AIM

To explore the demographics, training experiences and decision-making practices of registered nurses who assess patient acuity at triage in UK EDs.

METHOD

The study used an online, descriptive, cross-sectional survey design.

RESULTS

A total of 51 triage nurses from across the UK responded to the survey. Most (61) had achieved a bachelor's degree as their highest qualification, while 3 had postgraduate qualifications. Respondents had a median of seven years since qualifying, six years working in their current ED and five years working in triage and used a range of titles to describe their role. Low staffing and busy ED environments increased respondents' stress levels, which affected confidence in triage decision-making abilities among less experienced nurses. More experienced respondents coped with their stress by relying on their knowledge and skills. Not all respondents had received triage training, and for those that had, the training varied in type and frequency across EDs. Overall, respondents had low satisfaction with the amount, quality and content of the training they had received.

CONCLUSION

There is a need for safer staffing levels in EDs and greater support for staff welfare. The development of national standards, incorporating defined knowledge and skills and set time periods for refresher training, is required to enhance triage practice in EDs.

Triage: A Global Perspective

Triage is a process by which patients are assessed, classified, and sorted based on their presenting complaint and clinical urgency, providing assurance for timely access to emergency care. The goal is to get the right person to the right place, in the right amount of time, for the right reason, and within the context of resource availability. In many countries, a standardized triage system, underpinned through the use of guidelines, is used to provide clinicians with support and guidance. Triage is a globally adopted principle, and although triage guidelines are used in many countries, no single system has been internationally adopted. This paper discusses the importance of how triage process standardization improves patient care, resource management, and benchmarking at local, national, and international levels by applying 5 internationally recognized triage systems to fictional case studies. Evaluation of similarities and differences in severity scores, with a gap analysis, occurs.

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

BACKGROUND

Triage 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.

OBJECTIVES

To identify and examine the factors contributing to patient safety during the triage process.

METHODS

A 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.

RESULTS

Out 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.

CONCLUSIONS

This 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 PRACTICE

This 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 CONTRIBUTION

No patient or public contribution was required to design or undertake this review.

Rapid triage performed by nurses: Signs and symptoms associated with identifying critically ill patients in the emergency department

AIM

Aim of this study is to identify signs and symptoms associated with identifying critically ill patients by rapid triage assessment performed by nurses in an emergency department.

BACKGROUND

In some emergency services, the immediate assessment of critically ill patients occurs before opening the hospital formal registration and it is based on the nurse's experience. Studies on the topic are essential to improve this process.

DESIGN

This is a cross-sectional, quantitative study.

METHODS

This study was conducted in a Brazilian emergency department in 2017. Adult patients who presented potentially life-threatening symptoms underwent rapid triage to determine the medical urgency. Those identified as being critically ill were classified as high priority and streamed to the emergency room.

RESULTS

A total of 154 (84.6%) patients were classified as high priority from the total of 182 evaluations. Altered state of consciousness (35.2%) and altered skin perfusion (25.3%) were frequently identified. Signs and symptoms associated with identifying critically ill patients by rapid triage were alterations in ventilation (OR 6.09; p = 0.028), neurological dysfunction (OR 44.96; p < 0.001) and pain (OR 5.80; p = 0.004).

CONCLUSION

Nurses should value neurological and ventilation alterations and pain in patients during rapid triage, since these signs and symptoms are associated with high care priority.

Experiences of nurses working in a triage area: An integrative review

OBJECTIVES

The aim of the study is to review the literature on the experiences of nurses working in triage within emergency departments in hospitals.

REVIEW METHOD

This is an integrative review based on Cooper's five-stage framework.

DATA SOURCES

Primary research articles published from January 2008 to January 2018 were identified from seven databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane, ProQuest, and Scopus. A manual search of the end references from the published studies was also conducted to ensure a comprehensive search.

REVIEW METHOD

The included studies were evaluated independently by two authors based on the Joanna Briggs Institute appraisal checklist for Interpretive and Critical Research and Descriptive/Case Series to ensure methodological rigour and validity of the review.

RESULTS

The literature review included 35 articles; of which, 18 were qualitative studies, 13 were quantitative studies, and four were mixed-method studies. The findings from this review were categorised into three themes: (1) making judgement, (2) service delivery, and (3) effective communication.

CONCLUSIONS

The results from the review suggest that triage is a complex process involving decision-making and interprofessional communication. Nurses need to make judgement, consider factors affecting service delivery, and engage in effective communication, which is central to triaging. Decision-making is contextual and requires judicious judgement. Effective communication with fellow healthcare personnel and with patients and their caregivers is paramount to optimise care delivery. Finally, more support is needed to empower the nurses to cope with the work involved in triaging.

Using clinical based vignettes to further develop a mass gathering event triage tool

BACKGROUND

Previously published triage tools for use at mass gathering events (MGE) lack real-world validation. Non-health care professionals, such as first aiders, first responders, and advanced responders often undertake a triage role at MGEs. This research aimed to determine consistency in the decision-making of a MGE triage tool.

METHOD

Volunteer members of St John Ambulance Australia were recruited. Surveys included participant demographics and real-world clinical vignettes. Participants determined a triage category based on the vignettes and supplied triage tool. Demographics were analysed using descriptive statistics and responses to vignettes were analysed using Fleiss Kappa [p-bar].

RESULTS

There were 110 participants, the majority male (60%), having completed a Bachelor or higher degree (53.6%), and were non-health care professionals (70%). Of the vignettes, there was a slightly better than moderate agreement (items: 18, p-bar: 0.55). There was an excellent level of agreeance for the resuscitation category (items: 3, b-par 0.69), and moderate level of agreeance for the urgent (items: 10, b-par 0.52) and minor (items: 5, b-par 0.52) categories.

CONCLUSIONS

This research demonstrated similar findings to that of emergency department triage tool validation. Multi-country, multi-site, multi-type, real-world testing at MGEs is the next step to progress the development of this tool.

The use and feasibility of an online software system to support assessment of accuracy and consistency in applying the Australasian Triage Scale

BACKGROUND

The purpose of this study was to evaluate the use and feasibility of a software system called the Triage Quality Assessment Software in New South Wales emergency departments, to assist in evaluating triage decision accuracy and consistency of emergency nurses in applying the Australasian Triage Scale.

METHOD

A descriptive, exploratory study comprising of retrospective audit data and survey, was conducted 12-months post-implementation of the Triage Quality Assessment Software system.

RESULTS

Between January to December 2018, a total of 39 audits were completed comprising 4214 triage records, of which 3952 (93.3%) contained sufficient information to be evaluated. Triage decision accuracy was 58.3% with a moderate level (K_W=0.57) of consistency demonstrated. Overall feasibility was high (4.2). Findings confirmed learnability (4.3), usability (4.2) and acceptability (4.2) of Triage Quality Assessment Software.

CONCLUSION

This is the first software system to be developed to assist in evaluating triage decision accuracy and consistency in applying the Australasian Triage Scale. This study provides evidence that triage decision accuracy and consistency are detectable and quantifiable. The feasibility of Triage Quality Assessment Software is supported, with further testing needed to fully evaluate its role in emergency department triage quality improvement.