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Triage in emergency departments: national survey
Örebro University, Department of Health Sciences.
Örebro University, Department of Health Sciences.ORCID iD: 0000-0002-3964-196X
Örebro University, Department of Health Sciences.
2005 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 9, p. 1067-1074Article in journal (Refereed) Published
Abstract [en]

AIM:

This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments.

BACKGROUND:

Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue.

METHOD:

A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden.

RESULTS:

The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings.

CONCLUSION:

In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended.

RELEVANCE TO CLINICAL PRACTICE:

The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

Place, publisher, year, edition, pages
2005. Vol. 14, no 9, p. 1067-1074
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-3165DOI: 10.1111/j.1365-2702.2005.01191.xOAI: oai:DiVA.org:oru-3165DiVA, id: diva2:137192
Available from: 2006-11-03 Created: 2006-11-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Registered nurse-led emergency department triage: organisation, allocation of acuity ratings and triage decision making
Open this publication in new window or tab >>Registered nurse-led emergency department triage: organisation, allocation of acuity ratings and triage decision making
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.

In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.

The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.

The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.

In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2006. p. 73
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 10
Keywords
Accuracy, Canadian Triage and Acuity Scale, concordance, decision making, emergency department, patient scenarios, registered nurses, survey, think aloud, triage
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-732 (URN)91-7668-504-7 (ISBN)
Public defence
2006-11-24, Aulan, Örebro universitet, Örebro, 13:00
Opponent
Supervisors
Available from: 2006-11-03 Created: 2006-11-03 Last updated: 2017-10-18Bibliographically approved

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Göransson, Katarina E.Ehrenberg, AnnaEhnfors, Margareta

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