Decision making by emergency nurses in triage assessments

Area of Science:

• Emergency Medicine
• Nursing Practice
• Decision Science

Background:

• Patient triage in emergency departments is a critical decision-making process for prioritizing care.
• Limited research exists on the cognitive processes underlying triage decision-making by nurses.

Purpose of the Study:

• To describe triage decision-making processes in nurses with varying experience levels.
• To investigate the impact of situational uncertainty on nurses' use of probability judgments (heuristics) during triage.

Main Methods:

• Simulated six real-life triage cases presented to 20 nurses (varying experience).
• Collected and analyzed verbal protocols to understand decision-making steps.
• Utilized statistical tests (t-test) to assess the effect of uncertainty on probability judgments.

Main Results:

• Increased uncertainty in triage situations led all nurses to use probability judgments more frequently (P=0.03).
• The heuristic of representativeness was most commonly employed under uncertainty.
• No consistent agreement on triage categories was observed across nurses for specific cases.
• Experienced nurses reported higher confidence, relied more on past cases, gathered less data, and made more judgments.

Conclusions:

• Triage decision-making is influenced by uncertainty and relies on heuristics like representativeness.
• Past experiences significantly shape triage judgments, particularly for experienced nurses.
• Further research should explore variable category use, the role of experience, and develop standardized triage decision rules.