Round-off decision-making: Why do triage nurses assign STEMI patients with an average priority?

Patients with suspected ST elevation myocardial infarction should be classified with a high-priority triage level in the Emergency Department. Accurate triage can reduce mortality and morbidity in ST elevation myocardial infarction patients. Yet, half of these patients were given a low-priority score, especially the average classification (P3 on a P1-P5 scale).

To identify and clarify significant factors in the triage process that result in P3 assignment for patients with ST Elevation Myocardial Infraction diagnosis.

A retrospective-archive study was conducted at a tertiary hospital from January 2015 to November 2017. We collected and measured patients' characteristics, Emergency Department setting variables, and hospitalization characteristics. Data files were extracted from the electronic database (n = 140).

The results show several key factors that affect the decision to assign P3 in the triage process. Analysis of patients' sociodemographic characteristics show that being female (OR = 1.96, P = .05) or having Arab ethnicity (OR = 2.19, P = .01) is significant to P3 assignment. Number of cardiac events (P = .02) is the only noteworthy cardiologic comorbidity of all that were reviewed. A connection was observed between a patient being classified as average urgency and poor treatment outcomes, namely for the variables time to physician, total time in the Emergency Department, door-to-balloon time, and in-hospital mortality.

Average classification demonstrates the extreme risk involved in the triage process. Our research provides considerable data to identify factors that affect the decision to classify patients as P3.