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Improving Triage Accuracy: A Staff Development Approach
Carmen M Brosinski1, Autumn J Riddell, Sherwin Valdez
1Author Affiliations: Assistant Department Head (Ms Brosinski) and Clinical Nurse Specialist (Ms Riddell), Naval Medical Center Portsmouth, Virginia; and Clinical Nurse Specialist (Mr Valdez), Naval Medical Center San Diego, California.
Insights
Emergency Severity Index (ESI) refresher training significantly reduced undertriaged patients in the emergency department from 26.3% to 9.3%. This improvement enhances patient safety and timely care delivery.
Area of Science:
- Emergency Medicine
- Nursing Education
- Healthcare Quality Improvement
Background:
- Undertriage of emergency department patients leads to delayed care and increased risk of adverse outcomes.
- The Emergency Severity Index (ESI) is a critical tool for accurate patient categorization.
- Previous ESI training may not be sufficient to maintain high accuracy rates over time.
Purpose of the Study:
- To decrease the percentage of undertriaged patients to below the 10% benchmark.
- To evaluate the effectiveness of Emergency Severity Index refresher training on triage accuracy.
- To improve patient safety by ensuring appropriate and timely care.
Main Methods:
- An evidence-based staff development project was conducted over 7 months.
- Triage chart reviews were performed pre- and post-ESI training.
- Nurses received 1 month of Emergency Severity Index refresher training.
Main Results:
- Pre-training, 26.3% (102/388) of patients were undertriaged.
- Post-training, undertriage decreased to 9.3% (41/440), a statistically significant improvement (P < .001).
- The results met the study's objective of reducing undertriage to less than 10%.
Conclusions:
- Emergency Severity Index refresher training improves triage accuracy for all nurses, irrespective of experience.
- Enhanced triage accuracy reduces the risk of poor patient outcomes associated with delayed care.
- Continuous education is vital for maintaining high standards in emergency department triage.
Purpose:
The purpose of the process improvement initiative was to improve the percentage of undertriaged patients to less than 10% (benchmark) using the Emergency Severity Index tool. Undertriaged patients have an increased potential for poor outcomes due to a lengthier waiting room stay, which results in delay of care.
Description Of The Project:
An evidence-based project designed for staff development was conducted for a 7-month period. Project procedures consisted of triage chart reviews for a 3-month period during pre- and post-Emergency Severity Index training. Emergency Severity Index refresher training for nurses triaging in the emergency department was conducted for a 1-month period.
Outcome:
Chart reviews revealed that 102 of 388 patients (26.3%) were undertriaged before Emergency Severity Index training. After Emergency Severity Index training, chart reviews depicted that 41 of 440 patients (9.3%) were undertriaged. This difference was statically significant (P < .001), when tested using a 1-sided t test at the 95% confidence level and achieving at least 80% power.
Implications:
Regardless of previous training or years of emergency department nursing experience, triage refresher training has been shown to increase accuracy of triage categorization, thus leading to a decreased risk of poor patient outcomes.