Cognitive biases regarding utilization of emergency severity index among emergency nurses

The study aimed to measure emergency nurses' prevalence of cognitive biases when utilizing Emergency Severity Index (ESI). Moreover, the study aimed to measure the differences between cognitive biases and demographic variables.

Nurses use Emergency Severity Index (ESI) to prioritize the patients. Cognitive biases could compromise the clinical decisions of nurses in triage. Consequently, this hinders the delivery of safe and quality patient care.

A cross-sectional analytical approach invited 208 emergency nurses from four tertiary care hospitals. Institutional review board approval and permission from institutional heads were obtained. Informed consent was attained before data collection. Data was collected through a structured scenario-based questionnaire to measure cognitive biases at five levels of ESI. Descriptive and inferential statistics were obtained through v25.0 of SPSS.

Among the 86.6% response rate, 56.2% of nurses were male. 62.90% had nursing diplomas. Cognitive biases were present at all ESI levels one to five, in order 51%, 45%, 90%, 89%, and 91% among nurses. Premature closure 22%, tolerance to risk 12%, satisfying bias 25%, framing effect 22%, and blind obedience 34% from level one to five consecutively. Demographic variables, including males, experience between 2 and 5 years, general nursing as qualification, and without emergency severity index certification, were identified to encounter more cognitive biases when making triage decisions.

Numerous cognitive biases are considerably existing among emergency nurses when prioritizing patients. Cognitive de-biasing measures can improve triage decisions among nurses that could enhance quality care and patient safety.