Triage assessment of registered nurses in the emergency department

An Effective Triage Education Method for Triage Nurses: An Overview and Update

Background

Accurate decision-making in triage largely determines the amount of time required for a patient to be evaluated and treated while in the emergency department. Nursing staff worldwide have similar learning characteristics with similar working hours and common goals, despite the fact that different triage scales are used globally. The aim of this mini review is to present the different educational methods and identify the most effective for triage training of triage nurses.

Materials and Methods

We screened studies concerning triage education for nurses in Emergency Department, in databases including PubMed, CENTRAL and CINAHL. From November 12, 2023 to February 15, 2024, databases were searched for relevant literature. "Triage education" OR "triage training" AND "emergency nurses" OR "triage nurses" were the MeSH terms.

Results

There are various educational methods, including traditional, web-based, audiovisual, simulation-based, blended learning, and other specialized approaches. Almost all of the studies that are currently available demonstrate how effectively an educational intervention might improve nurses' comprehension of triage. Except for one, every study concluded that the educational intervention significantly improved nurses' triage knowledge. Comparing the included studies is challenging due to their heterogeneity, and applying the results in practice requires caution.

Conclusion

The majority of studies reported that educational interventions effectively increased nurses' triage knowledge. Blended learning in conjunction with refresher courses enhanced triage-related knowledge and decision-making; however, additional research is required to ascertain whether this approach is superior to the others and whether these improvements will last.

A new Bayesian method for the estimation of emergency nurses' thresholds and agreement in the context of telephone triage

Introduction

Triage is the process aimed at ensuring that patients receive a level and quality of care matching the urgency of their conditions. The present study focuses on telephone triage. We discuss the application of a new decision-making model to the task of telephone triage.

Methods

The model allows to estimate the nurse's Belonging Threshold (BT), which quantifies the minimum level of severity of an emergency scenario that leads the nurse to activate a rescue vehicle with emergency devices. The BT can be used as an index of the possible tendency of the nurse to systematically over-or under-triage. The model also provides accurate estimations of the level of agreement between different nurses, and between the nurses and reference experts, net of the noise due to the possible differences between the nurses' BTs.

Results and discussion

The model and the related experimental procedure were applied to a sample of 21 emergency nurses at the SUEM 118 Operations Center in Venice. We discuss how the model can be useful to identify nurses who would benefit from a training to improve the consistency of their application of the protocol, as well as to identify specific emergency scenarios for which the assignment of priority codes was most problematic.

Mental health triage tools: A narrative review

Mental Health Triage (MHT) tools may be defined as any clinician administered scale that specifies psychiatric signs or symptoms, proposes a corresponding service response, and determines priority categories based on the level of perceived acuity. Multiple MHT tools are used across different jurisdictions and care settings. This article summarizes the literature on MHT tools, describes the available tools and the supportive evidence, evaluates the impact and clinical applications, and compares their strengths and weaknesses. This review utilized a systematic review process to identify articles examining MHT tools. Several benefits of using MHT tools are described; however, in general, the supportive evidence for their use is lacking. A modified Australasian Triage Scale has the strongest evidence base for use in emergency settings; however, further data are needed to establish improved outcomes. There is limited evidence for the use of MHT tools in ambulatory or primary care settings. No evidence was found supporting any one tool as effective in guiding service responses across the entire clinical spectrum. Future research could focus on developing and evaluating MHT tools that service all levels of illness presentation. Additionally, more robust studies are required to support the use of MHT tools in emergency settings. Finally, there is an impetus for the development and evaluation of MHT tools in ambulatory, community, and primary care settings.

Development and psychometric evaluation of triage questionnaire (QTrix): Exploratory factor analysis and item response theory analysis

Introduction:

Triage errors can occur in all emergency departments, regardless of the type of triage system being used. One way to minimize triaging errors is by enhancing the triage officers’ knowledge and attitude on triage. The assessment of knowledge and attitude can be carried out by questionnaire assessment. This study aims to perform content, face, and construct validation on a newly developed triage questionnaire, QTrix, which is designed for healthcare personnel in a tertiary teaching hospital in Kelantan, Malaysia, that uses the three-tier Malaysian Triage Category system.

Methods:

This study consisted of two phases: the first phase was the questionnaire development phase, which included the content validity with the expert panel and the face validity using 30 respondents; and the second phase was the psychometric assessment phase, which included the item response theory and the exploratory factor analysis using 139 respondents.

Results:

The knowledge section with 12 remaining items was considered unidimensional by item response theory after removing items with extreme difficulty coefficients (outside the range of −3 to +3) and items with very low discrimination values (<0.35). After exploratory factor analysis, two items in the attitude section were removed due to low factor loadings (<0.3) and high item complexity. The reliability of the remaining 13 items in the attitude section was very good as shown by Cronbach’s alpha values of more than 0.8.

Conclusion:

The QTrix questionnaire is a well-validated and reliable tool to assess the knowledge and the attitude on triage. Its use among healthcare personnel can help minimize triaging errors in emergency departments that utilize the Malaysian Triage Category system.

Factors Associated with School Nurses' Triage Competency in South Korea

This study examined the factors associated with triage competency among school nurses in South Korea. Using a convenience sampling method, 386 school nurses employed in elementary, middle, or high schools completed a cross-sectional survey that included a modified version of the Triage Competency Scale for emergency room nurses. Information regarding experience working in schools and hospitals, education level, school types, age, emergency nursing care certifications, school locations, and serious emergency experience at school was collected. Analyses were performed using SPSS version 25.0, independent t-tests, analyses of variance, Spearman’s correlation, and ordinal logistic regression. Triage competency was higher for school nurses who were employed in metropolitan regions (odds ratio [OR] = 1.63, p = 0.017) and had serious emergency experience (OR = 1.76, p = 0.008). As the participants’ experience at schools or hospitals increased by one year, their triage competency score increased by 2% (OR = 1.02, p = 0.037) and 14% (OR = 1.14, p < 0.001), respectively. These findings could be used to develop policies and educational programs that promote school nurses’ triage competency. Further, they suggest the importance of establishing an organizational support system to develop guidelines and a feedback system to improve school nurses’ triage competency.

An epidemiological study of a patient population, triage category allocations and principal diagnosis within the emergency centres of a private healthcare group in the Emirate of Dubai, United Arab Emirates

Aim

To describe, compare and correlate the number of patients seen, their demographics, triage category allocations and principal diagnosis in four emergency centres; to better understand the patient population and triage practices in this setting.

Design

An observational, cross-sectional, epidemiological study.

Methods

Electronic medical records were retrospectively evaluated from patients triaged in each of the four emergency centres over six months. Descriptive statistics were used to describe the patient demographics and variance between triage category allocations.

Results

A total of 56,984 patient records were captured, with an equal gender split and the workforce being the largest patient population (20-50 years). Acute upper respiratory infection was the most prolific diagnosis, and lower acuity triage categories were allocated the most. There were inconsistencies in the application of triage systems between the emergency centres, the most obvious being the variance in triage system selection and application.

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.