Factors affecting emergency nurses' perceptions of the triage systems

The reliability and validity of triage tools in geriatric emergency departments: A scoping review

BACKGROUND

The nurse's ability to accurately identify urgent conditions and triage this vulnerable population tends to be complex and challenging. Little is known about the reliability and validity of common triage tools in geriatric patients.

AIM

To determine the reliability and validity of triage tools in geriatric emergency care and summarize the specific content of current triage tools for geriatric patients.

METHODS

The eligible literature was searched from the MEDLINE, CINAHL, EMBASE, and Cochrane Database using targeted search strategies. We defined the objectives and questions, set standards for article inclusion criteria, and conducted literature searching and screening. The mixed methods assessment tool (MMAT) appraised the article's quality. Finally, we extracted and analyzed the data from the included articles, summarizing the results. Endnote X9 was used for data extraction and collation.

RESULTS

Nine articles were eligible. These included six triage tools: CTAS, JTAS, KTAS, MTS, SETS, and ESI. The reliability of the CTAS was good when applied to triage geriatric patients. The SETS performed well in prehospital simulated triage. The ESI has moderate to excellent reliability. The CTAS has good to excellent validity, while the JTAS, KTAS, MTS, and ESI have fair to good results.

CONCLUSION

Several triage tools are useful in geriatrics, but the reliability and validity of these tools have mixed results. Applying triage tools to triage geriatric patients still has limitations.

The accuracy of triage classification using Emergency Severity Index

INTRODUCTION

Accurate emergency triage is essential for timely and appropriate care based on patient acuity. We sought to evaluate triage accuracy among emergency department (ED) nurses and examine potential influencing factors.

METHODS

We conducted an observational study using an electronic medical record chart review of 100 patients admitted at one of three EDs in a large academic medical system in the southern United States from December 1 to 7, 2021. Descriptive statistics were used to summarize the data. We compared the nurses' initial assigned triage acuity level documented in the medical chart with triage acuity assigned using the Emergency Severity Index Version 4 handbook and assessed inter-rater agreement using Cohen's kappa coefficient.

RESULTS

Overall triage accuracy was 67%, with most patients (62%) triaged as ESI level 3; under- and over-triage occurred in 25% and 8% of cases, respectively. Cohen's kappa coefficient was 0.437, indicating moderate interrater reliability between the triage nurses and the ESI handbook. Triage accuracy varied across ED locations and patient characteristics of sex (male: 55.6%, female: 72.3%), type of complaint (trauma: 57.1%, non-trauma: 69.4%), shift (day: 63.5%, night: 73.0%), and mode of arrival (ambulance: 80.8%, ambulatory: 65.2%, and private vehicle: 37.5%).

CONCLUSION

Triage inaccuracy may be attributed to a combination of nursing- and patient-specific factors. Further study of those factors associated with triage accuracy is warranted.

Factors influencing the classification accuracy of triage nurses in emergency department: analysis of triage nurses' characteristics

BACKGROUND

Triage nurses play a vital role in emergency departments (Eds), with the accuracy of the triage nurse significantly impacting patient care and departmental efficiency. However, there is a lack of exploration into whether the time it takes for triage nurses to triage patients affects accuracy.

METHOD

This study analyzed the electronic medical records of 787 patients and the characteristics of triage nurses, using statistical methods to determine factors affecting classification accuracy. Data were collected from a single general hospital between November 1 and November 30, 2023.

RESULTS

Findings revealed an 84.9% accuracy rate. Longer clinical experience (p = .001, CI = 1.094-2.052), as well as extended classification time (p = .002, CI = 1.338-2.916), significantly improved accuracy. Age and gender had no notable effect.

CONCLUSION

Enhancing triage nurse experience and allowing adequate classification time can improve accuracy, optimizing patient care and ED operations.

An evaluation of the capabilities of language models and nurses in providing neonatal clinical decision support

AIM

To assess the clinical reasoning capabilities of two large language models, ChatGPT-4 and Claude-2.0, compared to those of neonatal nurses during neonatal care scenarios.

DESIGN

A cross-sectional study with a comparative evaluation using a survey instrument that included six neonatal intensive care unit clinical scenarios.

PARTICIPANTS

32 neonatal intensive care nurses with 5-10 years of experience working in the neonatal intensive care units of three medical centers.

METHODS

Participants responded to 6 written clinical scenarios. Simultaneously, we asked ChatGPT-4 and Claude-2.0 to provide initial assessments and treatment recommendations for the same scenarios. The responses from ChatGPT-4 and Claude-2.0 were then scored by certified neonatal nurse practitioners for accuracy, completeness, and response time.

RESULTS

Both models demonstrated capabilities in clinical reasoning for neonatal care, with Claude-2.0 significantly outperforming ChatGPT-4 in clinical accuracy and speed. However, limitations were identified across the cases in diagnostic precision, treatment specificity, and response lag.

CONCLUSIONS

While showing promise, current limitations reinforce the need for deep refinement before ChatGPT-4 and Claude-2.0 can be considered for integration into clinical practice. Additional validation of these tools is important to safely leverage this Artificial Intelligence technology for enhancing clinical decision-making.

IMPACT

The study provides an understanding of the reasoning accuracy of new Artificial Intelligence models in neonatal clinical care. The current accuracy gaps of ChatGPT-4 and Claude-2.0 need to be addressed prior to clinical usage.

Triage Accuracy of Emergency Nurses: An Evidence-Based Review

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.

Triage: A Global Perspective

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

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

BACKGROUND

Triage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety.

OBJECTIVES

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

METHODS

A systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria.

RESULTS

Out of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule.

CONCLUSIONS

This review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients.

RELEVANCE TO CLINICAL PRACTICE

This review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety.

PATIENT OR PUBLIC CONTRIBUTION

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

Association between triage nurses' job satisfaction and professional capability: Results of a mixed-method study

AIM

This study aims to examine factors related to the job satisfaction of triaging nurses and their professional capability in the clinical setting.

BACKGROUND

Triage is a complex process that relies on making decisions in favour of the patient and his treatment. The professional capability of a triaging nurse is an important psychological construct of job satisfaction.

METHODS

The study used a mixed-method methodology, with data collection based on an explanatory research design. The research instrument in the quantitative part was a survey questionnaire, and in the qualitative part, a semi-structured interview. The results were integrated using the 'Pillar Integration Process'.

RESULTS

There are significant relationships between professional capability and job satisfaction. Six main topics were exposed: characteristics and traits, work organization, safety is the key, burdening circumstances, capability and self-evaluation.

CONCLUSION

Professional capability is associated with job satisfaction. The necessary managerial changes should be made to achieve job satisfaction and develop professional competence while focusing on already trained and competent triage nurses, as satisfied triage nurses will stay longer in the institution.

IMPLICATIONS FOR NURSING MANAGEMENT

The manager's job is to be aware of the level of job satisfaction, take care to develop their employee's professional capability and take action in case of disrupted balance.

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

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.

The nurse anesthetist’s perception of the role of case manager in four provinces of Indonesia

Introduction

Integrated and patient-focused healthcare is urgently needed, and there is an important role for case managers in implementing them. However, the understanding of healthcare providers, especially nurse anesthetists, about the role of case managers is still varied and is often considered only as a complement to hospital accreditation. This study aimed to determine the factors that influence the nurse anesthetist’s perception of the role of the case manager.

Methods

This cross-sectional study involved 369 nurse anesthetists who were selected using cluster sampling. Data collection was done using Google Forms. Furthermore, the data were analyzed using multiple logistic regression to identify the factors that influence the nurse anesthetists’ perception of the role of the case manager.

Results

From a total of 369 respondents, most (60%) have a positive perception of case managers. Marital status (AOR = 2.3; 95% CI: 1.27–4.15) and knowledge (AOR = 3.2; 95% CI: 2.03–5.07) were significant predictors of the nurse anesthetist’s perception of the role of the case manager.

Discussion

Even though the majority of nurse anesthetists have positive perceptions, socialization to increase knowledge about case managers is needed to reduce misperceptions about the role of case managers.

Factors Associated with School Nurses' Triage Competency in South Korea

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