A Computer-Based Decision Support System for Emergency Department Triage

Nurses' experiences of using a computer-based triage decision support system in the emergency department

BACKGROUND

Emergency department triage is a vital and complex decision-making process. There is limited knowledge about nurses' experiences with triage decision support systems in emergency departments.

AIM

This study was conducted to examine nurses' experiences with a computer-based triage decision support system in the emergency department.

STUDY DESIGN

This is a qualitative and phenomenological study. Data were collected through interviews from 14 triage nurses who used a triage decision support system in the emergency department of a university hospital. The nurses were recruited for semi-structured interviews. All interviews were recorded on a voice recorder and then transcribed. Data were analysed with the inductive content analysis method. The interviewer asked comprehensive questions about the nurses' experiences with the triage decision support system.

RESULTS

Three main and 11 sub-themes were elicited as a result of the analysis of the in-depth interviews: (a) the facilitating the triage decision theme, which included help in case of a dilemma, team collaboration, monitoring/supervision, and error reduction sub-themes; (b) the contribution to professionalism theme, which included ease of learning and teaching triage, professional autonomy, creating a database, and evidence-based practice sub-themes; (c) the areas that need improvement theme, which included reducing screen clicks, the effect of the hospital automation system performance, and clinical descriptors not included in the algorithm sub-themes.

CONCLUSION

Triage nurses stated that the decision support system was beneficial and facilitated decision-making. The decision support system enabled triage nurses to make their own decisions using their clinical knowledge and experience, without a restriction on their professional autonomy, and this was perceived positively. It was emphasized that this system could be a support tool in educating nurses new to triage. However, nurses stated that the pace of the decision support system was affected by the performance of the hospital automation system and that the large number of steps used for electing items caused a waste of time. They also added that these were technical areas that needed improvement.

RELEVANCE TO CLINICAL PRACTICE

The study provides important data that will help healthcare organizations and professionals better understand the emergency department nurse triage decision support system and gain a versatile, comprehensive, and general understanding.

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

BACKGROUND

Deciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience.

PURPOSE

This study was conducted to evaluate the effect of a "computer-based emergency department triage decision support system (DSS)," which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data.

METHODS

Single-group, pretest-posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied.

RESULTS

The effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest.

CONCLUSIONS

The DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.