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Reay G, Rankin JA, Then KL, Fung T, Smith-MacDonald L. Emergency department triage decision-making by registered nurses: An instrument development study. J Adv Nurs 2024; 80:4725-4735. [PMID: 38825956 DOI: 10.1111/jan.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/21/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024]
Abstract
AIM To develop and psychometrically test the triage decision-making instrument, a tool to measure Emergency Department Registered Nurses decision-making. DESIGN Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. METHODS Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision-making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4-point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. RESULTS The triage decision-making instrument is a 22-item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty-nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser-Meyer-Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X 2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of .596 factor 1, .690 factor 2, .749 factor 3 and .822 for factor 4. CONCLUSION The triage decision-making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. IMPACT The instrument is a first step in quantifying triage decision-making in real-world clinical environments. The triage decision-making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. STATISTICAL SUPPORT Dr. Tak Fung who is a member of the research team is a statistician. STATISTICAL METHODS Development, validation and assessment of instruments/scales. Descriptive statistics. REPORTING METHOD STROBE cross-sectional checklist. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The TDI makes the complexity of triage decision-making visible. Identifying the influence of decision-making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety.
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Affiliation(s)
- Gudrun Reay
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Tak Fung
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Osman AD, Yeak D, Ben-Meir M, Braitberg G. Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating thematic analysis. Emerg Med Australas 2024. [PMID: 39091123 DOI: 10.1111/1742-6723.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/26/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018-2019 and 2022-2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of 'front loading' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage. METHODS We conducted a cross-sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis. RESULTS The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). 'Valuable/vital resource' featured as a common response. Early decision-making, patient safety, staff and patient satisfaction emerged as consistent themes. CONCLUSIONS Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction.
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Affiliation(s)
- Abdi D Osman
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Nursing and Midwifery Discipline, College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Daryl Yeak
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - George Braitberg
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
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Alnaeem MM, Islaih A, Hamaideh SH, Nashwan AJ. Using primary healthcare facilities and patients' expectations about triage system: Patients' perspective from multisite Jordanian hospitals. Int Emerg Nurs 2024; 75:101476. [PMID: 38901305 DOI: 10.1016/j.ienj.2024.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Using primary healthcare facilities can decrease the tension and workload in emergency departments (EDs). This study aim to examine the patient's use of primary healthcare facilities before EDs visits and their expectations about the triage. METHODS A cross-sectional design was utilized in at various EDs in different hospitals. A convenience sample of 726 patients were enrolled and completed a self-administrated questionnaire. RESULTS The mean age of the participants was 38.1 (SD = 12.9). Most participants (68.2 %) did not have primary care physicians and did not want to know how long other patients waited (61.4 %). There are significant relationships between participants' desired to know how long other patients have been waiting and their age (X2 = 4.02, P < .05), education level (X2 = 13.5, P < .001), and current job (X2 = 9.90, p < .05). Also, periodic updates from EDs staff about the delays were significantly related to participants' age (X2 = 3.29), current job (X2 = 28.4), marital status (X2 = 8.93), and residency place (X2 = 9.94). CONCLUSION Educating patients about the triage system and the importance of using primary healthcare facilities is recommended to reduce ED waiting times and overload.
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Affiliation(s)
| | | | - Shaher H Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan.
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Gorick H. Ensuring effectiveness and safety in emergency department triage. Emerg Nurse 2024:e2205. [PMID: 39039922 DOI: 10.7748/en.2024.e2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 07/24/2024]
Abstract
Triage is the first stage of a patient's journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient's presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff.
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Affiliation(s)
- Hugh Gorick
- School of Health Sciences, University of East Anglia, Norwich, England
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Gorick H, McGee M, Smith T. Understanding the demographics, training experiences and decision-making practices of UK triage nurses. Emerg Nurse 2024:e2202. [PMID: 38778620 DOI: 10.7748/en.2024.e2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Hugh Gorick
- School of Health Sciences, University of East Anglia, Norwich, England
| | | | - Toby Smith
- University of East Anglia, Norwich, England
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Oh WO, Jung MJ. Triage-clinical reasoning on emergency nursing competency: a multiple linear mediation effect. BMC Nurs 2024; 23:274. [PMID: 38658947 PMCID: PMC11044571 DOI: 10.1186/s12912-024-01919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Triage is the first step in providing prompt and appropriate emergency nursing and addressing diagnostic issues. Rapid clinical reasoning skills of emergency nurses are essential for prompt decision-making and emergency care. Nurses experience limitations in emergency nursing that begin with triage. This cross-sectional study explored the mediating effect of perceived triage competency and clinical reasoning skills on the association between Korean Triage and Acuity Scale (KTAS) proficiency and emergency nursing competency. METHODS A web-based survey was conducted with 157 emergency nurses working in 20 hospitals in South Korea between mid-May and mid-July 2022. Data were collected utilizing self-administered questionnaires to measure KTAS proficiency (48 tasks), perceived triage competency (30 items), clinical reasoning skills (26 items), and emergency nursing competency (78 items). Data were analyzed using the PROCESS macro (Model 6). RESULTS Perceived triage competency indirectly mediate the relationship between KTAS proficiency and emergency nursing competency. Perceived triage competency and clinical reasoning skills were significant predictors of emergency nursing competency with a multiple linear mediating effect. The model was found have a good fit (F = 8.990, P <.001) with, a statistical power of 15.0% (R² = 0.150). CONCLUSIONS This study indicates that improving emergency nursing competency requires enhancing triage proficiency as well as perceived triage competency, which should be followed by developing clinical reasoning skills, starting with triage of emergency nurses.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, 02841, Seoul, South Korea
| | - Myung-Jin Jung
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, 02841, Seoul, South Korea.
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Moon SH, Kim SO. Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app. Int Emerg Nurs 2024; 72:101398. [PMID: 38198949 DOI: 10.1016/j.ienj.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Digital technology has enabled gamification methods to enhance triage education, reflecting an evolving healthcare landscape. OBJECTIVE To evaluate the effectiveness of a Gamification Triage Education App (GTEA) as a learning tool for emergency nurses, with a focus on creating an engaging and educationally effective platform for triage training. METHOD The GTEA was developed using no-code based software and expanded upon previous iterations, with added features such as points, rankings, instant feedback, and quest-based stories. From December 2021 to March 2022, 27 emergency room nurses from three hospitals in Korea were instructed to use GTEA for 100 min over the course of a week. The effects were measured before and after the intervention. RESULTS The results demonstrated a significant increase in triage accuracy from 4.3 ± 2.00 to 5.33 ± 1.47 (t = -2.18, p = 0.039), along with a substantial reduction in overtriage (t = 3.11, p = 0.004). Additionally, increases in critical thinking disposition, triage competency, and triage knowledge were observed (t = -3.11, p = 0.004; t = -2.72, p = 0.011; t = -3.14, p = 0.004, respectively). CONCLUSIONS The findings provide robust evidence for the effectiveness of gamification in triage training within emergency nursing.
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Affiliation(s)
- Sun-Hee Moon
- College of Nursing, Chonnam National University, Gwangju, South Korea.
| | - Su Ol Kim
- Department of Nursing, Kwangju Women's University, Gwangju, South Korea.
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Wolf L, Delao A, Clark P, Mizerek E, Moon MD. The Effect of Mandatory Triage Questions on Triage Processes: A Qualitative Exploratory Study. J Emerg Nurs 2024; 50:84-94. [PMID: 37480901 DOI: 10.1016/j.jen.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION The study purpose was to obtain an understanding of both the types of questions mandated for the triage encounter in emergency departments across the United States and how emergency nurses perceive the relevance of these questions to the triage process. METHODS A qualitative descriptive exploratory study using focus group data was used. Data were collected at an in-person emergency nursing conference held in September 2022. Data were analyzed using Mayring's 8-step process. RESULTS Participants (n = 35) voiced concerns about a lack of expertise at all points in the triage process. The overarching problem is reported as data required by regulatory agencies are conflated with triage assessment information. Participants in this study reported that the conflation of the triage assessment with regulatory compliance is causing significant issues in the ability of emergency nurses to appropriately evaluate patient presentations. Thematic categories were identified as who's assessing the patients? assessment or compliance? important questions, situationally important questions, questions asked before discharge, and the lack of emergency nurse input. DISCUSSION The conflation of regulatory data collection with patient assessment at the initial triage encounter challenges the ability of the emergency nurse to rapidly and accurately identify patients at risk of deterioration. We recommend that initial triage processes encompass questions that focus on establishing the stability of the patient and the safety of the waiting room and include inquiry relevant to the patient presentation.
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Suamchaiyaphum K, Jones AR, Markaki A. Triage Accuracy of Emergency Nurses: An Evidence-Based Review. J Emerg Nurs 2024; 50:44-54. [PMID: 37930287 DOI: 10.1016/j.jen.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Accurate triage assessment by emergency nurses is essential for prioritizing patient care and providing appropriate treatment. Undertriage and overtriage remain an ongoing issue in care of patients who present to the emergency department. The purpose of this literature review was to examine factors associated with triage accuracy in the emergency department. METHODS We conducted an evidence-based literature review using the Cumulative Index to Nursing and Allied Health Literature, PubMed, and Embase. The search focused on peer-reviewed articles in English, available in full text, published between January 2011 and December 2021. RESULTS A total of 14 articles met inclusion criteria and revealed the following 3 themes for triage accuracy: triage nurse characteristics, patient characteristics, and work environment. Triage nurses' accuracy rates ranged from 59.3% to 82%, with experience in triage associated with higher accuracy. Patient characteristics influenced triage accuracy, with nontrauma patients being undertriaged and trauma patients often overtriaged. The work environment played a role, as accuracy rates varied based on shift time and patient volume. Competing systems between prehospital and ED triage posed challenges and affected accuracy during fluctuations in patient volumes. DISCUSSION This review underscores the complex nature of ED triage accuracy. It highlights the importance of nurse experience, training programs, patient characteristics, and the work environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize triage accuracy and improve patient outcomes.
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Gorick H, McGee M, Wilson G, Williams E, Patel J, Zonato A, Ayodele W, Shams S, Di Battista L, Smith TO. Understanding triage assessment of acuity by emergency nurses at initial adult patient presentation: A qualitative systematic review. Int Emerg Nurs 2023; 71:101334. [PMID: 37716173 DOI: 10.1016/j.ienj.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness. AIMS This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation. METHODOLOGY Medline, CINAHL and Academic Search Complete were systematically searched to 15th December 2022. Data were analysed using thematic synthesis. Established themes were reviewed with GRADE-CERQual to evaluate certainty of evidence. RESULTS 28 studies were included in the review. Data analysis uncovered three superordinate themes of holistic reasoning, situational awareness, and informed decision-making. The findings show nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the wider situation in the emergency department. CONCLUSIONS This review presents new perspectives on nurses' decision-making processes about patient's acuity. Nurses holistically gather information about patients before translating that information into acuity scores. These actions are informed by their knowledge and experience; however, the wider situation also impacts their decisions. In turn, the nurses use interpretations of patients' acuity to control the wider situation.
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Affiliation(s)
- Hugh Gorick
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom.
| | - Marie McGee
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
| | - Gemma Wilson
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Emma Williams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Jaimik Patel
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Anna Zonato
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Wilfred Ayodele
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Sabina Shams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Luca Di Battista
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Toby O Smith
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom; University of Warwick, Coventry CV4 7AL, United Kingdom
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Fekonja Z, Kmetec S, Fekonja U, Mlinar Reljić N, Pajnkihar M, Strnad M. Factors contributing to patient safety during triage process in the emergency department: A systematic review. J Clin Nurs 2023; 32:5461-5477. [PMID: 36653922 DOI: 10.1111/jocn.16622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Zvonka Fekonja
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Urška Fekonja
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
| | | | - Majda Pajnkihar
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Matej Strnad
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Prehospital Unit, Department for Emergency Medicine, Community Healthcare Center Maribor, Maribor, Slovenia
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Butler K, Anderson N, Jull A. Evaluating the effects of triage education on triage accuracy within the emergency department: An integrative review. Int Emerg Nurs 2023; 70:101322. [PMID: 37597277 DOI: 10.1016/j.ienj.2023.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Triage accuracy can affect patient outcomes. Education to ensure nurses provide the most accurate triage scores is paramount for patient safety.The objective was to investigate whether ongoing triage education increases triage accuracy, knowledge or behaviour. METHOD An integrative review was conducted by searching five databases to identify studies that included triage-based education. A systematic search strategy was completed followed by analysis with critical appraisal using the Critical Appraisal Skills Programme, a TIDieR Checklist and thematic analysis. FINDINGS Four thousand five hundred seventy-six studies were retrieved, with 34 studies selected for inclusion. Thirty-one studies were quantitative, and three were mixed methods. 18 out of 34 studies showed improvement in triage accuracy. Seven showed increased knowledge. Six studies showed no improvement in triage accuracy. Sixteen studies assessed triage behaviour and showed improvement post-intervention, with five showing no changes. Only three studies compared interventions. Fifty-three opportunities for changes to triage accuracy, knowledge or behaviour were found, 41 showed improvements. CONCLUSION Triage education interventions can improve accuracy, knowledge and behaviour, but whether improvements are sustained needs further research.
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Affiliation(s)
- Kayla Butler
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; Emergency Department, Whakatane Hospital, Te Whatu Ora Hauora a Toi, Bay of Plenty, New Zealand.
| | - Natalie Anderson
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; Auckland Emergency Department, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Andrew Jull
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; National Institute for Health Innovation, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand
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Lee E, Baek G, Hwang Y. Effectiveness of the Patient's Severity Classification Competency Promotion Virtual Reality Program of Nursing Students during the COVID-19 Pandemic Period. Healthcare (Basel) 2023; 11:healthcare11081122. [PMID: 37107957 PMCID: PMC10137825 DOI: 10.3390/healthcare11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The purpose of this study was to develop a virtual reality-based nursing education program aimed at improving nursing students' severity classification competency. Severity classification in the emergency room is key to improving the efficiency of emergency room services worldwide. Prioritizing treatment based on correctly identifying the severity of a disease or an injury also ensures patients' safety. The five actual clinical scenarios in the program helped to promptly classify patients into five clinical situations based on the 2021 Korean Emergency Patient Classification Tool. Seventeen nursing students were in an experimental group that had access to a virtual reality-based simulation combined with clinical practice. Seventeen nursing students were in a control group that only participated in routine clinical practice. The virtual reality-based nursing education program effectively improved students' severity classification competency, performance confidence, and clinical decision-making ability. Although the pandemic continues, the virtual reality-based nursing education program provides realistic indirect experiences to nursing students in situations where clinical nursing practice is not possible. In particular, it will serve as basic data for the expansion and utilization strategy of virtual reality-based nursing education programs to improve nursing capabilities.
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Affiliation(s)
- Eunju Lee
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Gyuli Baek
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Yeonhui Hwang
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
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Yang J, Wan X, Yu P, Li X. Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey. Int Emerg Nurs 2023; 67:101264. [PMID: 36773513 DOI: 10.1016/j.ienj.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making. METHOD A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form. RESULT Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability. CONCLUSION Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.
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Affiliation(s)
- Jiayi Yang
- The First Hospital of China Medical University, Shenyang 110000, China
| | - Xinli Wan
- Fourth Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Pengyu Yu
- The People's Hospital Of Liaoning Province, Shenyang 110000, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang 110000, China.
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Jordan M, Hauser J, Cota S, Li H, Wolf L. The Impact of Cultural Embeddedness on the Implementation of an Artificial Intelligence Program at Triage: A Qualitative Study. J Transcult Nurs 2023; 34:32-39. [PMID: 36214065 DOI: 10.1177/10436596221129226] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Triage requires rapid determination of acuity and resources. Current modalities allow for individual judgment, with varied application of algorithmic rules. Although artificial intelligence can improve triage accuracy, gaps remain in understanding implementation facilitators and barriers, especially those related to the cultural understandings by nurses of emergency department presentations. The purpose of this study was to explore the cultural and technological elements of the implementation of an artificial intelligence clinical decision support aid (i.e., KATE) in an emergency nursing triage process in an urban community hospital on the West Coast of the United States. METHOD An exploratory qualitative study using semi-structured small group and individual interviews and constant comparison analysis strategies. The sample comprised 13 emergency department triage nurses at one site. Campinha-Bacote's theory of cultural competence framed the study. RESULTS Responses yielded the overall theme of We know these people and we know these things. Supporting categories included the problem of aire; just another checkbox; gut trumps data; higher acuity with no resources; and technology as a safety net. Participants reported reliance on clinical experience and cultural knowledge to assign acuity. DISCUSSION The implementation of an artificial intelligence program was initially received skeptically due to the acontextual nature of AI, but grew to be perceived as a safety net for triage decision making among emergency nurses.
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Affiliation(s)
| | | | | | - Hong Li
- Azusa Pacific University, CA, USA
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, IL, USA
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Ouellet S, Galliani MC, Gélinas C, Fontaine G, Archambault P, Mercier É, Severino F, Bérubé M. Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol. Nurs Open 2022; 10:2770-2779. [PMID: 36527423 PMCID: PMC10077397 DOI: 10.1002/nop2.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
AIM The purpose of this realist review was to assess what works, for whom and in what context, regarding strategies that influence nurses' behaviour to improve triage quality in emergency departments (ED). DESIGN Realist review protocol. METHODS This protocol follows the PRISMA-P statement and will include any type of study on strategies to improve the triage process in the ED (using recognized and validated triage scales). The included studies were examined for scientific quality using the Mixed Methods Appraisal Tool. The framework for this realist review is based on the Behaviour Change Wheel (BCW) and the context-mechanism-outcome (CMO) models. DISCUSSION Nurses and ED decision makers will be informed on the evidence regarding strategies to improve the quality of triage and the factors required to maximize their effectiveness. Research gaps may also be identified to guide future research projects on the adoption of best practices in ED nursing triage.
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Affiliation(s)
- Simon Ouellet
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Department of Health Sciences Université du Québec à Rimouski (UQAR) Rimouski Québec Canada
- Emergency Department Rimouski Hospital Rimouski Québec Canada
| | - Maria Cécilia Galliani
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
| | - Céline Gélinas
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
- Ingram School of Nursing McGill University Montreal Quebec Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital Montréal Québec Canada
| | - Guillaume Fontaine
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- Centre for Nursing Research Jewish General Hospital Montréal Québec Canada
| | - Patrick Archambault
- Department of Family Medicine, Emergency Medicine, Anesthesiology and Critical Care Université Laval Québec City Quebec Canada
- Research Center CISSS de Chaudière‐Appalaches Lévis Québec Canada
- VITAM ‐ Center for Sustainable Health Research Québec City Québec Canada
| | - Éric Mercier
- VITAM ‐ Center for Sustainable Health Research Québec City Québec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
| | - Fabian Severino
- Faculty of Nursing Université Laval Québec City Quebec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
| | - Mélanie Bérubé
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
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Soola AH, Mehri S, Azizpour I. 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. BMC Emerg Med 2022; 22:174. [PMID: 36303127 PMCID: PMC9613063 DOI: 10.1186/s12873-022-00729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Emergency department (ED) nurses and emergency medical technicians (EMTs) find themselves performing triage under time pressure and with limited information. Identifying an effective triage decision-making process can play a significant role in promoting patient safety. Experts are able to make faster and more effective decisions in emergencies than novices. Objective The current study aimed to identify the level of triage decision-making (TDM) and its’ predictors in ED nurses and EMTs based on self-reported levels of nursing proficiency in Benner’s theory from novice to expert. Materials and methods Out of 821 ED nurses and EMTs who met the inclusion criteria, 320 ED nurses and 152 EMTs were included in this descriptive-analytical research. Data were collected by a demographic information form and triage decision-making inventory (TDMI) and analyzed by SPSSv.22 software using descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression. Results The total score of TDMI in the ED nurses and EMTs was higher in the expert nurses than in the proficient, competent, advanced beginner and novices. Multiple linear regression analysis showed that self-reported levels of nursing proficiency, age, work experience, marital status and triage training course were predictors of TDM in ED nurses (P < .05), and self-reported levels of nursing proficiency, service location, work experience, and triage training course were predictors of TDM in EMTs (P < .05). Conclusion Understanding the predictors influencing TDM health professionals may facilitate the understanding of their training needs. The training needs of a novice and inexperienced person may be different from those of an expert person, it is recommended that the training methods be based on the experiences and professional levels of nurses so that the training provided is effective and quality. Moreover, to increase the TDM power and reduce TDM errors due to lack of experience, a system is suggested to be established to allow novice nurses in the first year to work with experienced nurses. Also it is suggested that the determining educational and training focus with regards to triage before entering the bedside be done based on predictors.
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Affiliation(s)
- Aghil Habibi Soola
- Department of nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saeid Mehri
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Islam Azizpour
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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AlShatarat M, Rayan A, Eshah NF, Baqeas MH, Jaber MJ, ALBashtawy M. Triage Knowledge and Practice and Associated Factors Among Emergency Department Nurses. SAGE Open Nurs 2022; 8:23779608221130588. [PMID: 36213615 PMCID: PMC9536099 DOI: 10.1177/23779608221130588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/12/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022] Open
Abstract
Objective The study aims at assessing the triage knowledge and practices and their associated factors among emergency department nurses employed in King Fahad Medical City (KFMC), Saudi Arabia. Method The study employed a cross-sectional, descriptive, and correlational design. Data collection was carried out from February 11, 2021, until April 27, 2021. The study included all emergency department nurses who were working in the KFMC during the data collection period and excluded those who were on leave at the time of data collection. A self-reported questionnaire with adequate validity and reliability was used. Statistical analysis was performed using the IBM SPSS Version 25 employing descriptive statistics, independent t-test, one-way ANOVA, and Pearson correlation test. Results A total of 147 emergency department nurses completed the study. Participants demonstrated generally high levels of triage knowledge and triage practice. However, knowledge deficit and incorrect practice related to some aspects were noted. There were no significant differences in triage knowledge and practice according to participants’ demographics including gender, job title, qualification, emergency nursing training, and previous training in triage (P > 0.05). Most participants (n = 141, 95.9%) had access to their triage systems and the majority (n = 79, 53.7%) utilize triage systems on a daily basis. Half said that only professional nurses performed the triage role (n = 69, 46.9%). There was a significant positive relationship between triage knowledge and practice (r = 0.486, P < 0.01). Conclusion The respondents had a high level of triage knowledge and practice. However, they have some areas of knowledge deficit and some deficiencies in the conversion of their knowledge into practice. The study recommends the development of further training and education in emergency nursing to address knowledge deficits and incorrect triage practices.
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Affiliation(s)
| | - Ahmad Rayan
- Faculty of Nursing, Zarqa University, Al-Zarqa, Jordan,Ahmad Rayan, Faculty of Nursing/Zarqa University, Faculty of Nursing. Al-Zarqa, Jordan.
Emails: ;
| | | | | | | | - Mohammed ALBashtawy
- Faculty of Nursing, Community Health Nursing, Al al-Bayt University, Al-Mafraq, Jordan
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Hoffman S, Voss JA, Hendrickx L, Gibson N. Effect of Emergency Severity Index Annual Competency Assessment on Mistriage. J Nurs Care Qual 2022; 37:356-361. [PMID: 35947860 DOI: 10.1097/ncq.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited evidence identifying best practices to promote competency of accurate assignment of the Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage. LOCAL PROBLEM Triage-trained nurses do not receive competency training in an ESI triage tool. METHODS A retrospective chart review of 150 patients was completed to evaluate mistriage rates before and after triage-trained nurses completed an ESI competency assessment. RESULTS The retrospective chart review showed no statistically significant difference in mistriage from pre- to postintervention (P = .8535). CONCLUSIONS Implementation of an ESI annual competency assessment aligns well with an emerging theme in the literature that ED nurses should be provided with ongoing education that reinforces knowledge and implementation of ESI triaging.
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Affiliation(s)
- Stefanie Hoffman
- Sanford Acute Care, Sanford Sports Complex Acute Care, Sioux Falls, South Dakota (Dr Hoffman); College of Nursing, South Dakota State University, Rapid City (Dr Voss); South Dakota State University College of Nursing-Aberdeen Campus, Aberdeen (Dr Hendrickx); and North Central Heart Institute, Sioux Falls, South Dakota (Dr Gibson)
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Meysman J, Morreel S, Lefevere E, Verhoeven V, De Graeve D, Monsieurs KG, Philips H. Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system. Int Emerg Nurs 2022; 63:101191. [PMID: 35810679 DOI: 10.1016/j.ienj.2022.101191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS This process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). DESIGN & METHODS Semi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. RESULTS Through a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. CONCLUSION Based on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.
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Affiliation(s)
- Jasmine Meysman
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium.
| | - Stefan Morreel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Eva Lefevere
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Veronique Verhoeven
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Reliability and Validity of a New Computer-Based Triage Decision Support Tool: ANKUTRIAGE. Disaster Med Public Health Prep 2022; 17:e162. [PMID: 35765149 DOI: 10.1017/dmp.2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively. METHODS ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated. RESULTS The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased (P < 0.05). CONCLUSIONS ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.
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Kopka M, Feufel MA, Balzer F, Schmieding ML. Triage Capability of Laypersons: Retrospective, Exploratory Analysis (Preprint). JMIR Form Res 2022; 6:e38977. [PMID: 36222793 PMCID: PMC9607917 DOI: 10.2196/38977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health–related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient’s health. Recently, patient-facing decision support systems, commonly known as symptom checkers, have been developed to assist laypersons in these decisions. Objective The purpose of this study is to identify factors influencing laypersons’ ability to self-triage and their risk averseness in self-triage decisions. Methods We analyzed publicly available data on 91 laypersons appraising 45 short fictitious patient descriptions (case vignettes; N=4095 appraisals). Using signal detection theory and descriptive and inferential statistics, we explored whether the type of medical decision laypersons face, their confidence in their decision, and sociodemographic factors influence their triage accuracy and the type of errors they make. We distinguished between 2 decisions: whether emergency care was required (decision 1) and whether self-care was sufficient (decision 2). Results The accuracy of detecting emergencies (decision 1) was higher (mean 82.2%, SD 5.9%) than that of deciding whether any type of medical care is required (decision 2, mean 75.9%, SD 5.25%; t>90=8.4; P<.001; Cohen d=0.9). Sensitivity for decision 1 was lower (mean 67.5%, SD 16.4%) than its specificity (mean 89.6%, SD 8.6%) whereas sensitivity for decision 2 was higher (mean 90.5%, SD 8.3%) than its specificity (mean 46.7%, SD 15.95%). Female participants were more risk averse and overtriaged more often than male participants, but age and level of education showed no association with participants’ risk averseness. Participants’ triage accuracy was higher when they were certain about their appraisal (2114/3381, 62.5%) than when being uncertain (378/714, 52.9%). However, most errors occurred when participants were certain of their decision (1267/1603, 79%). Participants were more commonly certain of their overtriage errors (mean 80.9%, SD 23.8%) than their undertriage errors (mean 72.5%, SD 30.9%; t>89=3.7; P<.001; d=0.39). Conclusions Our study suggests that laypersons are overcautious in deciding whether they require medical care at all, but they miss identifying a considerable portion of emergencies. Our results further indicate that women are more risk averse than men in both types of decisions. Layperson participants made most triage errors when they were certain of their own appraisal. Thus, they might not follow or even seek advice (eg, from symptom checkers) in most instances where advice would be useful.
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Affiliation(s)
- Marvin Kopka
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Cognitive Psychology and Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Malte L Schmieding
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Development of Nurse-Sensitive, Emergency Department-Specific Quality Indicators Using a Modified Delphi Technique. J Nurs Care Qual 2022; 37:E59-E66. [PMID: 35404876 DOI: 10.1097/ncq.0000000000000627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no identified set of nursing-sensitive, emergency department (ED)-specific quality indicators. PURPOSE The purpose of this study was to address the gap in quality indicators specific to the emergency care environment and identify a list of nursing-sensitive, ED-specific quality indicators across ED populations and phases of the ED visit for further development and testing. METHODS A modified Delphi technique was used to reach initial consensus. RESULTS Four thematic groups were identified, and quality indicators within each were rank ordered. Of the 4 groups, 21 quality indicators were identified: triage (6) was ranked highest, followed by special populations (4), transitions of care (4), and medical/surgical (7). CONCLUSIONS Many of the recommended metrics were questionable because they are nonspecific to the ED setting or subject to influences in the emergency care environment. Some identified priorities for quality indicator development were unsupported; we recommend that alternate methodologies be used to identify critical areas of quality measurement.
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Ibrahim BE. Sudanese emergency departments: a study to identify the barriers to a well-functioning triage. BMC Emerg Med 2022; 22:22. [PMID: 35135475 PMCID: PMC8822826 DOI: 10.1186/s12873-022-00580-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triage system is a sorting system that categorizes patients on the basis of the severity of their condition and the availability of the resources in the emergency department. There has been little attention in the public literature to triage systems in Sudan. The aim of this study was to explore the triage system and identify the barriers in its application in hospitals in Sudan. METHODS A cross-sectional hospital based study was conducted at eight hospitals in Khartoum during December 2020. A multi-stage cluster sampling was applied. Data were obtained by interviewing emergency department staff using a structured questionnaire. The data were analyzed using statistical package for social sciences to find the association between various variables by chi-square test. RESULTS Most of the respondents stated that the triage system was deficient. Most of the participants of this study agreed that the role played by the administration in taking legislative decisions is crucial in improving the triage system. Among the factors found to be significant to a well-functioning triage system were, the need for substantial capital expenditure, p-value: 0.026, prudent legislative decisions, p-value: 0.026, adequate training of staff on means of performing efficient triaging, p-value: 0.007 and raising the awareness of the staff on the correct application of triage guidelines, p-value: 0.017. CONCLUSION Currently there is no formal triage system in the State of Khartoum and has yet to be established. Policy making by administrators will play an important role in its implementation. It is suggested that prompt executive orders on improving the current triage system in Khartoum, should be carried out sooner than later, as the ripple effects of a well-functioning triage will decrease the average length of stay, mortality and morbidity rates and will eventually increase the patient's satisfaction.
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Affiliation(s)
- Bayan E Ibrahim
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
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Professional Self-Concept, Job Stress, and Triage Competency Among Emergency Nurses: Secondary Data Analysis of a Cross-Sectional Survey. J Emerg Nurs 2022; 48:288-298. [DOI: 10.1016/j.jen.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/17/2022]
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Chmielewski N, Moretz J. ESI Triage Distribution in U.S. Emergency Departments. Adv Emerg Nurs J 2022; 44:46-53. [PMID: 35089282 DOI: 10.1097/tme.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The accurate triage of arriving emergency department (ED) patients is a key component of emergency nursing practice. Overtriage assignment of patients misallocates scarce resources in a time of department overcrowding, whereas patient undertriage can create risks for negative patient outcomes secondary to care delays. Limited evidence is available regarding ED triage accuracy. It is estimated that appropriate adherence to the Emergency Severity Index (ESI) triage tool and assigning triage categories could be as low as 60% (McFarlane, 2019a, 2019b). The purpose of this retrospective observational study was to examine the 2019 triage distribution of 954,847 ED encounters at 25 hospitals. Comparisons were then made with the spreads identified in the ESI Implementation Handbook (Gilboy, Tanabe, Travers, & Rosenau, 2020). Study results reflect the presence of wide variations in distribution when compared with the expected spread published by Gilboy et al. (2020). These variations illustrate the need for further facility-level evaluation. ESI Level 2 percentages varied from as little as 2.6% to as high as 69% of each facility's ED visit population. Examining an individual facility's annualized triage distribution may serve as a swift method in determining whether additional investigation into triage accuracy is warranted. EDs must implement and sustain an ongoing quality control program to achieve and maintain triage inter- and intrarater reliability. Further research is needed on the value of triage inaccuracy with real-time feedback on nurses' clinical decision-making and patient outcomes. It is also imperative that the expected and observed ESI triage distribution in U.S. EDs is updated when established accuracy quality control programs are present.
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Mulyadi M, Dedi B, Hou WL, Huang IC, Lee BO. Nurses' experiences of emergency department triage during the COVID-19 pandemic in Indonesia. J Nurs Scholarsh 2021; 54:15-23. [PMID: 34741408 PMCID: PMC8661666 DOI: 10.1111/jnu.12709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the experiences of nurses working in emergency departments in selecting and triaging patients during the COVID-19 pandemic. DESIGN Descriptive phenomenology was applied in this study. METHODS Data were collected from nurses working at hospitals in Indonesia using snowball sampling and telephone interviews. A total of 10 emergency nurses participated, and Colaizzi's method of data analysis was applied. FINDINGS Six themes and 10 subthemes emerged. The main themes were "extreme challenges in triage," "feeling of responsibility under uncontrolled spread and infection," "physical and psychological exhaustion," "discovering strategies under difficult circumstances," "looking for positive reinforcement," and "optimism in togetherness." Nurses had to deal with the challenge of COVID-19 in the ED triage, interestingly so, the nurses they have shown the development of professional responsibility. Nurses are also experienced in finding patient selection and triage strategies and the sense of optimism that may influence strategy and practice during the COVID-19 pandemic. CONCLUSIONS This findings identify nurses' experiences in dealing with the extreme challenges of emergency department triage as well as their associated strategies and optimism. CLINICAL RELEVANCE Providing support to emergency nurses, improving emergency department triage, and community empowerment are suggested as strategies to improve nursing care during the COVID-19 pandemic.
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Affiliation(s)
- Mulyadi Mulyadi
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department Emergency & Trauma Nursing, School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Blacius Dedi
- Karya Husada College of Health Sciences Semarang, Semarang, Indonesia
| | - Wen-Li Hou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chin Huang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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Wolf LA. Response to Amberson Letter. J Emerg Nurs 2021; 47:531. [PMID: 34275526 DOI: 10.1016/j.jen.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Lisa Adams Wolf
- Director, Emergency Nursing Research, Emergency Nurses Association, 930 E Woodfield Road, Schaumburg, IL 60173.
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Wolf LA, Delao AM, Evanovich Zavotsky K, Baker KM. Triage Decisions Involving Pregnancy-Capable Patients: Educational Deficits and Emergency Nurses' Perceptions of Risk. J Contin Educ Nurs 2021; 52:21-29. [PMID: 33373003 DOI: 10.3928/00220124-20201215-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In areas where obstetric services are not available, emergency departments often become the default for unplanned obstetric care, yet emergency nurses are not universally trained in the identification and treatment of obstetric emergencies. The purpose of this study was to explore emergency nurses' perception of acuity in the triage of pregnant or postpartum patients presenting to the emergency department with high-risk complaints and to identify facilitators and challenges to the accurate identification and treatment of these patients. METHOD A mixed-methods study was conducted using chart review data (N = 12,766) and focus group data (N = 39) from five emergency departments in the eastern United States. RESULTS In 86.5% of cases, pregnancy status was not documented. Ninety-four percent of pregnant patients with a systolic blood pressure over 140 mmHg were under-triaged. The overall theme of the qualitative data was acuity blindness, with identified barriers to assessment that included educational needs and triage processes and workflow issues. CONCLUSION There are significant knowledge deficits in the care of patients presenting with high-risk conditions associated with pregnancy. [J Contin Educ Nurs. 2021;52(1):21-29.].
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The Other Side of Immediate Bedding: A Call to Action to the Research Community. J Emerg Nurs 2021; 47:529-530. [PMID: 34275525 DOI: 10.1016/j.jen.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
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Yoon J, Son H. Factors Associated with School Nurses' Triage Competency in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168279. [PMID: 34444029 PMCID: PMC8392305 DOI: 10.3390/ijerph18168279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Jaehee Yoon
- Wolchon Elementary School, 132, Mokdongjungang-ro, Yangcheon-gu, Seoul 07980, Korea;
| | - Heesook Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea
- Correspondence:
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Establishing Research Priorities for the Emergency Severity Index Using a Modified Delphi Approach. J Emerg Nurs 2021; 47:50-57. [PMID: 33390221 DOI: 10.1016/j.jen.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The accuracy of an initial ED triage decision has been reported to drive the clinical trajectory for ED patients, and, therefore, this assessment is critical to patient safety. The Emergency Severity Index-a 5-point score assigned by a triage nurse and based on disease acuity, patient potential for decompensation, and anticipated resource use-is used both in the United States and internationally. In the US, the Emergency Severity Index is used by up to 94% of the academic medical center emergency departments. In 2020, the Emergency Nurses Association acquired the intellectual property rights to the Emergency Severity Index and is responsible for its maintenance and improvement. OBJECTIVE The purpose of this study was to establish a research agenda for the improvement of individual and institutional understanding and use of the Emergency Severity Index. METHODS Modified Delphi process was used with 3 rounds of data collection. RESULTS Round 1 yielded 112 issues, which were collapsed into 18 potential research questions in 4 general categories: education and training (6 questions), workplace environment (3 questions), emergency care services (7 questions), and special populations (2 questions). These questions were used in round 2 to establish importance. Round 3 yielded a rank ordering of both categories and research questions. DISCUSSION The research priorities as set through the use of this modified Delphi process align well with current gaps in the literature. Research in these areas should be encouraged to improve the understanding of educational, environmental, and process challenges to emergency nurses' triage decisions and accuracy of Emergency Severity Index assignments.
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Kuehl S, Stanley J, Nelson K, Collings S. The Serious Self-Harm Risk of "Mixed Presenters," People Who Presented to New Zealand Emergency Departments for Self-Harm and Other Reasons: A Cohort Study. Arch Suicide Res 2021; 25:475-490. [PMID: 32065083 DOI: 10.1080/13811118.2020.1715904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to investigate if "Mixed Presenters," people who present to emergency departments at least twice within 28 days, once for self-harm and once for another reason (any order), have an increased risk of subsequent serious self-harm compared to self-harm only repeat presenters. Self-harm coded emergency department data from the Multi-level Intervention for Suicide Prevention (MISP) study was utilized to identify people with at least two presentations to one of eight District Health Boards between 2010 and 2012. First eligible presentation pairs determined their "Mixed Presenter" or "Self-harm Only Presenter" status. The sample was linked to admission and mortality datasets. Survival analysis over the 30-month timeframe was used to determine which presenter group was at higher risk of serious self-harm. Mixed Presenters (n = 1,544), four times more common than Self-harm Only Presenters (n = 377), had an estimated 60% reduced risk of serious self-harm compared to Self-harm Only Presenters. Compared to men, women had a 3.5 times (HR 3.53, 95% CI 2.47-5.06) increased risk. Having an urgent triage code allocated at the index presentation and being admitted at that index presentation were associated with increased serious self-harm risk for Self-harm Only Presenters compared to Mixed Presenters. This study confirms that two presentations for self-harm within a short timeframe indicate high risk of serious self-harm in the future. As men often die following single attempts, and Mixed Presenters may transition to being Self-harm Only Presenters, each presentation for self-harm requires serious attention.
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Abstract
The most common site for hospital sentinel events due to care delays, secondary to waiting and/or inefficient processes, occurs in the emergency department (ED). Decreasing patient length of stay in an ED is a key initiative for many hospitals in order to maximize both quality and efficiency. The purpose of this practice improvement project was to (1) standardize front-end processes across a 6-hospital health system, (2) move non-sorting-related clinical questions out of triage, and (3) improve door-to-triage and door-to-provider times. The project occurred within a 6-hospital East Coast health system. This was a continuous quality improvement initiative utilizing the Donabedian theoretical model, plus the DMAIC method, for process improvement. A system-wide performance work team was formed including ED leaders and staff; site-specific implementation teams were also formed. Rapid triage implementation was effective in producing statistically significant improvement in door-to-triage, door-to-provider, and ED length of stay for discharged patients at 3 of the 6 sites. Further performance improvement projects in this area are needed to better understand the generalizability of this process in other EDs. Furthermore, from a leadership perspective, additional investigation is needed into the cost savings as well as shared labor opportunities that may exist when policies and processes are standardized across a system's service line.
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Affiliation(s)
- Nicholas Alen Chmielewski
- Berkeley Research Group, LLC, Emeryville, California (Dr Chmielewski); St. Charles Hospital, Catholic Healthcare Services of Long Island, Port Jefferson, New York (Ms Tomkin); Good Samaritan Hospital, Catholic Healthcare Services of Long Island, West Islip, New York (Ms Edelstein)
| | - Theresa Tomkin
- Berkeley Research Group, LLC, Emeryville, California (Dr Chmielewski); St. Charles Hospital, Catholic Healthcare Services of Long Island, Port Jefferson, New York (Ms Tomkin); Good Samaritan Hospital, Catholic Healthcare Services of Long Island, West Islip, New York (Ms Edelstein)
| | - Gara Edelstein
- Berkeley Research Group, LLC, Emeryville, California (Dr Chmielewski); St. Charles Hospital, Catholic Healthcare Services of Long Island, Port Jefferson, New York (Ms Tomkin); Good Samaritan Hospital, Catholic Healthcare Services of Long Island, West Islip, New York (Ms Edelstein)
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Improving ED Emergency Severity Index Acuity Assignment Using Machine Learning and Clinical Natural Language Processing. J Emerg Nurs 2020; 47:265-278.e7. [PMID: 33358394 DOI: 10.1016/j.jen.2020.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Triage is critical to mitigating the effect of increased volume by determining patient acuity, need for resources, and establishing acuity-based patient prioritization. The purpose of this retrospective study was to determine whether historical EHR data can be used with clinical natural language processing and machine learning algorithms (KATE) to produce accurate ESI predictive models. METHODS The KATE triage model was developed using 166,175 patient encounters from two participating hospitals. The model was tested against a random sample of encounters that were correctly assigned an acuity by study clinicians using the Emergency Severity Index (ESI) standard as a guide. RESULTS At the study sites, KATE predicted accurate ESI acuity assignments 75.7% of the time compared with nurses (59.8%) and the average of individual study clinicians (75.3%). KATE's accuracy was 26.9% higher than the average nurse accuracy (P <.001). On the boundary between ESI 2 and ESI 3 acuity assignments, which relates to the risk of decompensation, KATE's accuracy was 93.2% higher, with 80% accuracy compared with triage nurses 41.4% accuracy (P <.001). DISCUSSION KATE provides a triage acuity assignment more accurate than the triage nurses in this study sample. KATE operates independently of contextual factors, unaffected by the external pressures that can cause under triage and may mitigate biases that can negatively affect triage accuracy. Future research should focus on the impact of KATE providing feedback to triage nurses in real time, on mortality and morbidity, ED throughput, resource optimization, and nursing outcomes.
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Johnson KD, Punches BE, Smith CR. Perceptions of the Essential Components of Triage: A Qualitative Analysis. J Emerg Nurs 2020; 47:192-197. [PMID: 33097241 DOI: 10.1016/j.jen.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Triage is an important process to determine severity of illness and prioritize patient emergencies while also ensuring patient safety. The emergency nurse must use critical thinking and decision-making to identify life-threatening emergencies and improve patient outcomes. However, the addition of risk screenings and quality improvement initiatives has extended the triage process time, which may increase interruptions and opportunities for errors. The purpose of this descriptive qualitative study was to determine emergency nurse perceptions of current triage processes and categorize essential and nonessential triage components. METHODS Focus groups of frontline emergency nurses who regularly conduct triage in the emergency department were conducted to discuss perceptions of triage assessments and questions. The 3 focus group discussions were digitally recorded and transcribed. Data analysis consisted of descriptive statistics of the sample and the conventional content analysis of the transcripts. RESULTS A total of 12 emergency nurses participated in the study. The overall theme that emerged surrounding essential triage components was a perceived conflict between individualized care and maintaining systems and processes. This theme consisted of 4: (a) must ask, (b) actions of triage, (c) relevant but not urgent for triage, and (d) not perceived as relevant. CONCLUSION This study identified the perceptions of emergency nurses surrounding the urgency of triage components in the emergency department. Emergency nurses perceived some assessments as essential to determining "sick versus not sick," and other triage components were able to be delayed, streamlining the triage process.
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Ausserhofer D, Zaboli A, Pfeifer N, Solazzo P, Magnarelli G, Marsoner T, Siller M, Turcato G. Errors in nurse-led triage: An observational study. Int J Nurs Stud 2020; 113:103788. [PMID: 33120136 DOI: 10.1016/j.ijnurstu.2020.103788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nurses play a crucial role in correctly prioritizing patients entering emergency departments. However, little is known of the accuracy of nurse-led triage systems. OBJECTIVES (1) To determine the frequency of nurse-led triage errors within the Manchester Triage System; (2) to explore patient, work environment and individual nurse factors associated with triage errors; and (3) to explore associations between triage errors and patient outcomes (i.e., length of emergency department stay, hospitalization, and 7- and 30-day mortality). SETTING This study was conducted in one emergency department in Northern Italy. PARTICIPANTS A random sample of 5% (n = 1,929) of all eligible patients accessing the emergency department over an 18-month period. METHODS For this retrospective observational study, electronic health record data on triage errors (i.e., incorrect presentational flowchart, specific discriminator and/or priority level) and triage nurses were combined with routine data on patient characteristics, outcomes and the work environment. To explore relationships between these variables, we performed univariate and multivariate logistic regression analyses. RESULTS We observed triage errors in 16.3% of patients (n = 314). These were significantly associated with patients' emergency department and hospital stays. Analyses revealed that when > one patient was triaged every 15 min (OR: 2.112;95%CI: 1.331-3.354), older patients (OR: 1.009; 95%CI: 1.003-1.015) with > than two chronic conditions (OR: 1.506; 95%CI: 1.091-2.081) and orange or red priority codes (OR: 1.314; 95%CI: 1.046-1.651,) whose triage nurse had previous experience with another triage system (OR: 3.189; 95%CI: 2.455-4.14) had higher odds of triage errors. CONCLUSION We provided primary evidence on triage errors. Confirming our findings on the prevalence, nature and consequences of such errors will require further prospective multicenter studies. Considering patient factors (e.g., age, polychronicity) as additional discriminators could make the nurse-led triage process using the Manchester Triage System more accurate. Investigating the roles of triage nurses' training and background and the emergency department work environment on their mental models regarding the triage process will require qualitative research.
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Affiliation(s)
- Dietmar Ausserhofer
- College of Health Care-Professions Claudiana, Lorenz-Böhler-Str. 13, 39100 Bolzano-Bozen, Italy; Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
| | - Pasquale Solazzo
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
| | - Gabriele Magnarelli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
| | - Tania Marsoner
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
| | - Marianne Siller
- Nursing Management, (SABES-ASDAA), Sparkassen-Str. 4, 39100 Bolzano-Bozen, Italy.
| | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Rossini-Str. 5, Merano-Meran 39012, Italy.
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Magnusson C, Herlitz J, Axelsson C. 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. Scand J Trauma Resusc Emerg Med 2020; 28:81. [PMID: 32807224 PMCID: PMC7430123 DOI: 10.1186/s13049-020-00766-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Christer Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Phiri M, Heyns T, Coetzee I. Patients' experiences of triage in an emergency department: A phenomenographic study. Appl Nurs Res 2020; 54:151271. [PMID: 32650888 DOI: 10.1016/j.apnr.2020.151271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Triage, predominantly done by nurses in the emergency department, is globally accepted as essential to prioritise the acuity of patient care. Patients with low acuity illness often express frustration and disgruntlement with the triage process and long waiting times. Consequently, some patients leave the emergency department unseen, which may negatively affect their health outcomes. In order to change practice efficiently, triage nurses should provide patients an opportunity to share their experiences. OBJECTIVE This paper deals with exploring the understanding patients' emergency department triage experiences. DESIGN A phenomenographic approach was used to explore and understand patients' triage-related experiences in an emergency department. METHODS AND CONTEXT Semi-structured individual interviews were conducted with 10 purposively selected participants who were triaged as yellow or green in an emergency department in a public hospital in Botswana. Collaborative creative hermeneutic data analysis by 11 nurses working in the same context identified categories of description. RESULTS Three categories of description emerged from patient experiences, namely triage environment, triage nurse and waiting times. Following data analysis, the nurses reflected that they were not aware of the consequences in the way triage was currently conducted. Consensus was reached that they should move away from focusing on a biomedical model towards person-centred triage, which then underpinned the outcome space for triage in the emergency department. CONCLUSION The reality in the emergency department is that patients' needs, wishes and expectations are neglected, leaving them dissatisfied and disgruntled. Moving towards person- centred triage may improve their overall experience of triage. What is already known about this topic? WHAT THIS PAPER ADDS
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Affiliation(s)
- Moitshepi Phiri
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Tanya Heyns
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa.
| | - Isabel Coetzee
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
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Nursing Research Priorities in the Pediatric Emergency Care Applied Research Network (PECARN): Reaching Consensus Through the Delphi Method. J Emerg Nurs 2019; 45:614-621. [DOI: 10.1016/j.jen.2019.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022]
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Triage emergency nurse decision-making: Incidental findings from a focus group study. Int Emerg Nurs 2019; 48:100791. [PMID: 31494074 DOI: 10.1016/j.ienj.2019.100791] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Emergency Department (ED) triage decision-making is a complex process. Triage scales are used to determine patient acuity level, however, they do not provide information on how nurses make triage decisions. This focus group study was part of a larger project to develop a psychometrically sound instrument to measure triage decision-making by nurses; the Triage Decision-Making Instrument. We report important incidental findings that emerged during the study that the participants identified as factors impeding triage decision-making. METHODS Three focus groups were conducted with 11 triage Registered Nurses. They commented on the instrument items and identified factors that influence triage decision-making. Transcripts were analyzed using thematic analysis. RESULTS Three powerful inter-related themes emerged central to encumbering triage decision-making: competing systems (pre-hospital versus the ED), fluctuating patient volume resulting in 'intra-Canadian Triage and Acuity Scale' triaging, and personal capacity including experience and 'triage fatigue'. DISCUSSION The findings demonstrate how interrelated system factors impede nurses triage decision-making. Triage nurses require support in their role and initiatives are needed to reduce the pressure they feel in relation to resolving system issues. Larger system issues and the capacity of the individual decision-makers must be accounted for within the context of increasing effectiveness and safety of ED triage.
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Sherafat A, Vaezi A, Vafaeenasab M, Ehrampoush M, Fallahzadeh H, Tavangar H. Responsibility-Evading Performance: The Experiences of Healthcare Staff about Triage in Emergency Departments: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:379-386. [PMID: 31516525 PMCID: PMC6714131 DOI: 10.4103/ijnmr.ijnmr_217_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Correct triage is one of the most important issues in delivering proper healthcare in the emergency department. Despite the availability of various triage guidelines, triage is not still appropriately implemented. Therefore, this study was conducted to investigate the role of different underlying factors in triaging emergency patients through a qualitative approach. Materials and Methods: This study was conducted by conventional content analysis. For this purpose, 30 interviews were conducted with 25 participants. The participants included triage nurses, emergency general physicians, emergency medicine specialists, and expert managers at different position rankings in hospitals and educational and administrative centers in Yazd, selected by purposeful sampling. Data were collected through in-depth and unstructured interviews from April 2017 to January 2018, and then analyzed by inductive content analysis. Results: Four categories of profit triage, exhibitive triage, enigmatic, and tentative performance triage were drawn from the data, collectively comprising the main theme of responsibility-evading performance. Conclusions: The dominant approach to the triage in the emergency departments in a central city of Iran is responsibility evasion; however, the triage is performed tentatively, especially in critical cases. To achieve a better implementation of triage, consideration of the underlying factors and prevention of their involvement in triage decision-making is necessary.
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Affiliation(s)
- Asghar Sherafat
- Department of Health in Disaster and Emergency, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Aliakbar Vaezi
- Department of Nursing, School of Nursing and Midwifery, Research Center for Nursing and Midwifery Care in Family Health, Shahid Sadughi University of Medical Science, Yazd, Iran
| | - Mohammadreza Vafaeenasab
- Physiatrist, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadhassan Ehrampoush
- Department of Environmental Health Engineering, Environmental Sciences and Technology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Tavangar
- Department of Nursing Education, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Wolf LA, Perhats C, Delao AM, Clark PR, Moon MD, Zavotsky KE. Assessing for Occult Suicidality at Triage: Experiences of Emergency Nurses. J Emerg Nurs 2018; 44:491-498. [PMID: 29502904 DOI: 10.1016/j.jen.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Screening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately. METHODS Qualitative exploratory study using focus-group data. FINDINGS Effective and accurate suicidality assessment occurs not by asking a single question but also with the assessment of patient behaviors and presentation (appearance, hygiene, etc). When emergency nurses suspected occult suicidality, additional actions (finding private space, keeping patients safe, and passing on information), took priority. DISCUSSION The Joint Commission recommends using clinical judgment tools for the final determination of safety for a patient at suspected risk of suicide, as research findings suggest that a screening tool can identify persons at risk for suicide more reliably than a clinician's personal judgment. Our participants report that when they assessed suicide risk at triage, it was usually by asking a single question such as "Do you have thoughts or plans to harm yourself?" and they expressed concern about the effectiveness of doing so. Participants described their efforts to improve suicide screening across the duration of the patient's ED stay through an iterative process of assessment that included further probing and eliciting, evaluating, and reacting to the patient's response.
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Affiliation(s)
- Lisa A Wolf
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ.
| | - Cydne Perhats
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Altair M Delao
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Paul R Clark
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Michael D Moon
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
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