Triage in an adult emergency service: patient satisfaction

Patient satisfaction with nursing triage care in hospital emergency departments: Scoping review

INTRODUCTION

Perceived quality of patient care is essential in healthcare, particularly in hospital emergency departments (EDs), where the triage process, performed by nurses, is fundamental yet under-researched. The aim is to explore patient satisfaction in triage, identify improvement opportunities, and provide guidance for future research to enhance ED care.

METHODOLOGY

A scoping review was conducted across databases including PubMed, CINAHL, Scopus, Cochrane, Joanna Briggs, Google, and Google Scholar. Empirical articles from January 2014 to December 2023 were selected, excluding non-face-to-face triage, pediatrics, and aspects not related to nursing care.

RESULTS

Six studies were included, demonstrating a high level of patient satisfaction with triage, especially regarding nurses' skills and professional competence, courtesy, respect, interest, and empathy. However, pain management and confidence in treatment scored lower. Patient satisfaction was related to age, gender, reason for consultation, and perception of nurses' professional competence.

DISCUSSION

Similar opinions were observed regarding areas for improvement in care and nurses' skills in triage. The need for qualitative research and more rigorous sampling methods was highlighted.

CONCLUSIONS

Nurse training and education in triage are crucial for patient satisfaction. Further research is needed to evaluate the effectiveness of nursing interventions in triage and address remaining challenges.

Patient experience of emergency department triage: An integrative review

BACKGROUND

Emergency department (ED) triage is often patients' first contact with a health service and a critical point for patient experience. This review aimed to understand patient experience of ED triage and the waiting room.

METHODS

A systematic six-stage approach guided the integrative review. Medline, CINAHL, EmCare, Scopus, ProQuest, Cochrane Library, and JBI database were systematically searched for primary research published between 2000-2022 that reported patient experience of ED triage and/or waiting room. Quality was assessed using established critical appraisal tools. Data were analysed for descriptive statistics and themes using the constant comparison method.

RESULTS

Twenty-nine articles were included. Studies were mostly observational (n = 17), conducted at a single site (n = 23), and involved low-moderate acuity patients (n = 13). Nine interventions were identified. Five themes emerged: 'the who, what and how of triage', 'the patient as a person', 'to know or not to know', 'the waiting game', and 'to leave or not to leave'.

CONCLUSION

Wait times, initiation of assessment and treatment, information provision and interactions with triage staff appeared to have the most impact on patient experience, though patients' desires for each varied. A person-centred approach to triage is recommended.

Patients' experiences with an obstetric telephone triage system: A qualitative study

BACKGROUND

Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied.

OBJECTIVE

The purpose of this study is to explore patients' experiences with obstetric telephone triage.

METHODS

A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding.

RESULTS

Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations.

CONCLUSION

Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care.

PRACTICE IMPLICATIONS

Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.

Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol

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.

Psychosocial care for people with suicidal behavior from the perspective of users and health professionals

OBJECTIVE

To understand the implications of the assistance provided to people with suicidal behavior within the scope of the Psychosocial Care Network, from the perspective of users and health professionals.

METHOD

A qualitative research, under the theoretical framework of complex and methodological thinking in Grounded Theory. Interviews were conducted from May to December 2017, with users assisted due to suicidal behavior and with health professionals in psychosocial care settings. The comparative data analysis technique was used.

RESULTS

18 users and health professionals participated. Non-acceptance intensifies users' introspection, demotivation and hopelessness, increasing the difficulty of exposing their desires. In situations of embracement, availability and bonding with professionals, patients feel more open, to the point of giving new meanings to life and reducing thoughts of death.

CONCLUSION

Weaknesses and potentialities were noticed in the care provided by health professionals to users with suicidal behavior, within the scope of the Psychosocial Care Network. The need for management committed to the quality of care in the face of the risk of suicide stands out.

Interaction between Sound and Thermal Influences on Patient Comfort in the Hospitals of China’s Northern Heating Region

Previous studies have found that hospitals are often inadequately ventilated in the heating region of China, which causes an increased risk of negative impacts on patients. The complex interaction between thermal comfort and acoustics presents considerable challenges for designers. There is a wide range of literature covering the area of the interaction between the sound–thermal, sound–odor, and acoustic–visual influences, but a focused research on the sound –thermal influence on comfort in hospitals has not been published yet. This paper describes a series of field measurements and subjective evaluations that investigate the thermal comfort and acoustic performance of eighteen hospitals in China. The results showed that the thermal comfort in the monitored wards was mostly acceptable, but the temperatures tended to be much higher and the humidity much lower, in practice than they were designed to be in the heating season. The most significant conclusion is that a positive thermal stimulus can create a comfortable thermal environment, which can improve patients’ evaluation of the acoustics, while a negative stimulus has the opposite effect. A comfortable acoustic environment also caused patients to positively evaluate thermal comfort. Moreover, the relationship between thermal and sound effects in the overall evaluation showed that they are almost equal.

Embracement with risk classification: relationship of justice with the user

ABSTRACT Objective: to describe the conception of justice of nurses and users regarding the Risk Classification in Emergency Unit; to analyze the conception of justice in the implementation of the Risk Classification in Emergency Unit from the user’s recognition; to discuss, from Axel Honneth’s Theory of Recognition, justice with the user in the Risk Classification in Emergency Unit. Method: qualitative research of descriptive, exploratory typology, which used action research as a method. Bardin’s Content Analysis was carried out. Results: a category was created: “Justice versus Injustice” and three subcategories: “Autonomy/Freedom versus Heteronomy/Subordination”; “Communication versus Hermeneutic Problems”; “Contributions versus Conflicts”. Final considerations: Embracement with Risk Classification presents difficulties in its interpretation and effectiveness; there are situations of disrespect that compete against the required ethics. Justice addressed by this study will be achieved by an emergency access system that meets user expectations, recognizing it as a subject of rights.

Effectiveness of Implementing Emergency Severity Index Triage System in a Selected Primary Health Care Center in Oman: A Quasi-Experimental Study

BACKGROUND

Because most primary health care centers in Oman do not use a formal triage system, there are no available data on the effectiveness of implementing this system.

PURPOSE

To assess the effectiveness of implementing an Emergency Severity Index triage system in primary health care centers in Oman.

METHODS

A pretest/posttest quasi-experimental design was used. The sample comprised 187 patients before Emergency Severity Index implementation and 102 patients after implementation. Waiting time, length of stay, patient satisfaction, and accuracy of classification were compared across the 2 groups.

RESULTS

The mean time (hour:minute) from registration to triage was reduced in the post-Emergency Severity Index group (mean = 0:18, SD = 0:14) compared with the pre-Emergency Severity Index group (mean = 0:23, SD = 0:19) (t = 2.59, P = 0.01). Furthermore, the mean length of stay was reduced in the post-Emergency Severity Index group (mean = 1:09, SD = 0:37) compared with that of the preimplementation group (mean = 1:24, SD = 0:41) (t = 3.10, P = 0.002). Patient satisfaction in the postimplementation group was improved (mean = 66.95, SD = 8.33) compared with that of the Emergency Severity Index group (mean = 65.01, SD = 8.73), but it did not reach statistical significance (t = -1.83, P = 0.07). The inter-rater agreement of triage level in post-Emergency Severity Index implementation markedly improved in the postimplementation group (Cohen's kappa = 0.910, P < 0.001) compared with that of the preimplementation group (Cohen's kappa = 0.082, P = 0.005).

CONCLUSIONS

Although this is a single-setting study, the results have shown that the Emergency Severity Index system can contribute to a decrease in the negative crowding outcomes in primary health care centers in Oman.

Humanization in urgent and emergency services: contributions to nursing care

OBJECTIVE

To analyze the evidence of researches carried out on humanization in urgent and emergency care, considering their contributions to nursing care.

METHODS

Integrative review of LILACS, CINAHL, SciELO, Web of Science, SCOPUS, and BDENF databases, using the keywords: humanization of care, urgencies, emergencies, emergency medical services, and nursing.

RESULTS

The search resulted in a total of 133 publications, of which 17 were included in the scope of this review. The analysis enabled the elaboration of the evidence units: 'Reception with Risk Classification: a device with good results' and 'Barriers and difficulties to use the guidelines of the National Humanization Policy'.

CONCLUSION

The Reception with Risk Classification was evidenced as the main device for the effective implementation of the National Humanization Policy and there are barriers to its effectiveness related to the organization of health care networks, structural problems, and multi-professional work.

RESPONSIVENES OF THE EMBRACEMENT WITH RISK CASSIFICATION: USER´S EVALUATION IN EMERGENCY CARE UNIT

ABSTRACT Objectives: to evaluate, with users, the responsiveness of the embracement with risk classification in an emergency care unit and to analyze the association between socio-demographic and care variables with the evaluation of responsiveness. Method: quantitative, correlational study approach, developed in an emergency care unit in Santa Catarina (Brazil) with 459 users. A validated questionnaire was applied, with 25 questions, evaluated by Likert scale and organized in the domains: dignity, communication, agility, social support and facilities. The data were organized and processed with the Epi Info software and OpenEpi, using descriptive statistics and chi-square test. Results: the domains that stood out with good responsiveness were dignity (97.8%), communication (93.9%) and facilities (91.1%). Agility obtained the lowest percentage (56.6%). The overall mean of good responsiveness of the user embracement with Risk Classification was 82.1%. There was a significant statistical difference in the characteristics of users' profile (gender, age, marital status and schooling) and the number of times the user was attended in the service with good responsiveness. Conclusion: the user embracement with risk classification presented good responsiveness; however, there is a need for improvements, especially related to the agility of care. The evaluation of responsiveness by users is associated with socio-demographic and care variables.

Acolhimento com classificação de risco em unidade de pronto atendimento: estudo avaliativo

RESUMO Objetivo Descrever a avaliação da estrutura, processo e resultado do Acolhimento com Classificação de Risco, na perspectiva dos médicos e enfermeiros de uma Unidade de Pronto Atendimento. Método Estudo avaliativo, descritivo, quantitativo, desenvolvido em Santa Catarina. Dados coletados com instrumento validado e adaptado, constituído por 21 itens distribuídos nas dimensões Estrutura (instalações), Processo (atividades e relações no atendimento) e Resultado (efeitos do atendimento). Na análise, aplicaram-se a estatística descritiva, o cálculo do Ranking Médio e o da Pontuação Média. Resultados A amostra foi de 37 participantes. Dos 21 itens avaliados, 11 (52,4%) tiveram Ranking Médio entre 3 e 4, e nenhum atingiu o máximo (5 pontos). A “Priorização dos casos graves” e o “Atendimento primário por gravidade do caso” obtiveram maior Ranking Médio (4,5), enquanto a “Discussão sobre fluxograma” revelou menor Ranking (2,1). As dimensões Estrutura, Processo e Resultado atingiram, respectivamente, as pontuações médias 23,9, 21,9 e 25,5, indicando avaliação Precária (17,5 a 26,1 pontos). Conclusão Há precarização do Acolhimento com Classificação de Risco, em especial no que se refere ao processo, que obteve menor nível de satisfação dos participantes.