Signs of Severity (SOS) ED Escalation Guide: Bridging the Experience Gap

This study evaluated the introduction of an ED Escalation Guide (EDEG) as an early warning system for the many new graduate nurses in the emergency department. The EDEG is a chart that provides ED-appropriate parameters to prioritize both vital signs and critical symptoms. Scenario quizzes were used to evaluate its usefulness.

Comparative quizzes that required prioritizing the urgency of patient symptoms were given to emergency nurses with varying levels of experience, with and without the use of the EDEG. The quizzes, with scenarios adapted from the Emergency Severity Index (ESI) Handbook, were given to ED RNs 1 week apart; the second quiz included availability of the EDEG. Scores were compared based on demographic data that included years of ED experience and clinical expertise.

RNs with less than 1 year of ED experience showed a 29% improvement in scenario scores with use of the EDEG. Those with more experience had similar scores with and without the availability of the guide, but increasing experience led to higher scores. A log kept by new emergency nurses using the EDEG showed accuracy and greater confidence in notifying ED physicians.

RNs with less than 1 year of ED experience might not recognize or report critical symptoms without a guide. The EDEG helps new emergency nurses to prioritize the urgency of clinical symptoms better and gives them the confidence to report these clinical symptoms. Early warning systems, such as the EDEG, can be valuable tools for inexperienced emergency nurses.