Triage Training in Iran from 2010 to 2020: A Systematic Review on Educational Intervention Studies

Evaluation of Emergency Severity Index (ESI) triage quality by nurses and associated factors in Iran

INTRODUCTION

The triage process of patients in emergency departments is done by nurses in Iran. it is necessary to pay attention to the ability of nurses in patients' triage in order to have a correct picture of the status of the emergency department, so the aims of this study is to investigate the quality of nurses' triage using the Emergency Severity Index (ESI) method and related factors.

MATERIALS AND METHODS

This is a descriptive study which was performed on all 900 patients referring to the emergency department during 12 months from 2019 to 2020 in the Triage unit of two trauma center hospitals affiliated to Isfahan university of medical sciences. Data collection tools included patients' demographic, nurses' demographic and occupational checklist, and ESI Triage Form. To analyze the data, SPSS software was used, descriptive and analytic statistics were used, P < 0.05 was considered statistically significant.

RESULTS

No significant difference was observed between the quality level of triage by nurses and physicians (P > 0.05), the results of independent t-test showed that nurses in the over triage group have a higher average age and work experience. In the under triage level, the frequency of female nurses was significantly higher than male nurses (P < 0/05).

CONCLUSION

Accurate and fast triage of patients is the key to successful performance in the emergency department. Therefore correct implementation of triage and identifying the need for nurses for training and identifying existing deficiencies are of utmost importance.

The Role of Large Language Models (LLMs) in Providing Triage for Maxillofacial Trauma Cases: A Preliminary Study

BACKGROUND

In the evolving field of maxillofacial surgery, integrating advanced technologies like Large Language Models (LLMs) into medical practices, especially for trauma triage, presents a promising yet largely unexplored potential. This study aimed to evaluate the feasibility of using LLMs for triaging complex maxillofacial trauma cases by comparing their performance against the expertise of a tertiary referral center.

METHODS

Utilizing a comprehensive review of patient records in a tertiary referral center over a year-long period, standardized prompts detailing patient demographics, injury characteristics, and medical histories were created. These prompts were used to assess the triage suggestions of ChatGPT 4.0 and Google GEMINI against the center's recommendations, supplemented by evaluating the AI's performance using the QAMAI and AIPI questionnaires.

RESULTS

The results in 10 cases of major maxillofacial trauma indicated moderate agreement rates between LLM recommendations and the referral center, with some variances in the suggestion of appropriate examinations (70% ChatGPT and 50% GEMINI) and treatment plans (60% ChatGPT and 45% GEMINI). Notably, the study found no statistically significant differences in several areas of the questionnaires, except in the diagnosis accuracy (GEMINI: 3.30, ChatGPT: 2.30; p = 0.032) and relevance of the recommendations (GEMINI: 2.90, ChatGPT: 3.50; p = 0.021). A Spearman correlation analysis highlighted significant correlations within the two questionnaires, specifically between the QAMAI total score and AIPI treatment scores (rho = 0.767, p = 0.010).

CONCLUSIONS

This exploratory investigation underscores the potential of LLMs in enhancing clinical decision making for maxillofacial trauma cases, indicating a need for further research to refine their application in healthcare settings.

Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app

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.

Effectiveness of Distance Training Based on Simple Triage and Quick Treatment System (START) Triage System in Pre-Hospital Emergency

OBJECTIVE

Triage is the key to success in managing many injured people with limited resources. Therefore, triage training for crisis team medical staff is critical. This study aimed to evaluate the effectiveness of asynchronous learning on immediate care personnel based on the Simple Triage and Quick Treatment System (START) triage system.

METHODS

In this quasi-experimental study, asynchronous learning based on the START triage system was performed on the immediate care staff of Ahvaz Jundishapur University of Medical Sciences from February 2021 to December 2021. Sixty pre-hospital emergency medical staff were randomly assigned to intervention and control groups. Intervention group participants were provided an asynchronous digital training module, and control group participants received the usual training. Data were collected in both groups as pre-test and post-test with demographic information and knowledge assessment questionnaires.

RESULTS

Distance triage training based on the START triage system has a significant effect on the level of awareness of the need for triage and knowledge (awareness) and performance (individual efficiency) of immediate care in the intervention group compared to before training (P < 0.001).

CONCLUSION

Considering the positive results of the pre-organizing model on raising the level of awareness of immediate care personnel, the use of this training method in triage in emergency medicine and retraining workshops could be considered.

A comparison between the impacts of lecturing and flipped classrooms in virtual learning on triage nurses' knowledge and professional capability: an experimental study

BACKGROUND

The quality of triage in emergency department depends on regular evaluation of triage nurses' professional capabilities and development of programs to improve them. Flipped classrooms are a new approach to learning which can be employed to improve professional capabilities. The present study aims to compare the impact of lecturing to flipped classrooms in virtual learning on the knowledge and professional capabilities of triage nurses in the emergency departments of the state hospitals of Yazd province in south-western Iran in 2022.

METHODS

The present study is an experimental work of research. Seventy-four triage nurses participated in the study. Seventy-four triage nurses were randomly allocated to the two groups, including flipped classrooms (group B) and lecturing (group A). The data collection instruments were an emergency department triage nurses' professional capability questionnaire and a triage knowledge questionnaire. The collected data were analyzed in SPSS v.22 using independent t-test, chi-squared test, and repeated measures analysis of variance. Level of significance was set at p ≥ 0.05.

RESULTS

The participants' mean age was 33.1 ± 4.3 years. As measured one month after the education, the triage knowledge mean score of the nurses who were educated using the flipped classroom method (9.29 ± 1.73) was higher than that of the nurses who were educated via lecturing (8.45 ± 1.788), and the difference was statistically significant (p = 0.001). Also, measured one month after the education, the professional capability mean score of the nurses who were educated using the flipped classroom method (140.27 ± 11.744) was higher than that of the nurses who were educated via lecturing (132.84 ± 10.817), and the difference was statistically significant (p = 0.006).

CONCLUSION

There was a significant difference between the pretest and posttest knowledge and professional capability mean scores of both groups immediately after the education. However, measured one month after the education, the mean and standard deviation of the knowledge and professional capability scores of the triage nurses who had been educated via flipped classrooms were higher than those of the nurses in the lecturing group. Thus, virtual learning using flipped classrooms is more effective than lecturing in improving triage nurses' knowledge and professional capability in the long run.

Investigating the professional capability of triage nurses in the emergency department and its determinants: a multicenter cross-sectional study in Iran

BACKGROUND

Planning to improve the professional capabilities of triage nurses requires determining the level of professional capabilities and its determinants. In this regard, the present study was conducted to determine the professional capability of triage nurses and its determinants for the first time in Iran.

METHODS

A descriptive cross-sectional multicenter study was conducted in 2022. The research population included all nurses working in triage units of emergency departments of seven selected hospitals in Fars Province, south of Iran. The samples were selected using convenience sampling. The data collection tools were the "Triage nurses' professional capability questionnaire in the emergency department" and a questionnaire to investigate determinants of triage nurses' professional capability. Descriptive and analytical (Pearson's correlation test and multiple linear regression analysis) were used for data analysis in the SPSS software version 27. P values ≤ 0.05 were considered significant.

RESULTS

Out of 580 participants, 342 (59%) were female. The professional capability of triage nurses was at a moderate level with a mean score of 124.11 ± 14.72. The mean score of clinical competence, psychological empowerment, and professional commitment was 71.56 ± 9.67, 19.86 ± 3.95, and 32.69 ± 3.54, respectively. The results of multiple linear regression analysis showed that 5 factors, including participation in educational courses (p < 0.001), having clinical experience and specialized knowledge in emergency department (p < 0.001), error registry and assessment system (p < 0.001), managers' support (p < 0.001), and recruiting experienced staff (p = 0.018) affected the nurses' professional capability.

CONCLUSION

In the present study, the triage nurses had moderate levels of professional capability. It is necessary that nursing managers develop effective plans to improve the professional capability of triage nurses in emergency departments to enhance the quality and effectiveness of emergency services.

Accuracy of nurses’ performance in triage using the emergency severity index and its relationship with clinical outcome measures

Emergency department (ED) triage in hospitals is part of their emergency structure carried out by nurses in emergency units. There have not been many studies available on nurses' performance in triage based on the emergency severity index (ESI). This present study aimed to investigate the nurses’ performance in triage with regard to the emergency severity index and its relation to clinical outcome measures in the emergency department. This was a cross-sectional study. The hospitalization record of 600 patients who arrived at the emergency department of Sanandaj Social Security Hospital was randomly assessed based on the accuracy of triage performed by nurses. The data analysis procedure was done by employing STATA software version 12, as well as Fisher's exact test, independent t-test, and one-way ANOVA. Findings of the study revealed that nurses’ overall performance in triage showed that 82.67% of nurses had perfect triage accuracy, 12.17% had low-level triage accuracy and 5.17% had high-level triage accuracy. There was an association between nurses' performance in triage with the disposition of patients (p=0.029) and length of stay (p=0.009). Results of the study highlighted the importance of theoretical and practical triage training courses for nurses and provided a foundation for identifying effective factors for decreasing the length of stay and disposition of patients in emergency care units.

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.

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.