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Nursing Prioritization of Emergency Waiting Room Patients: A Multisite Observational Study
Journal of Emergency Nursing
|August 6, 2026
Summary
Emergency nurses often deviate from acuity-arrival order when assigning beds, prioritizing patients based on complex factors beyond triage scores. This inconsistency raises concerns about emergency care quality and safety.
Area of Science:
- Emergency Medicine
- Nursing Practice
- Healthcare Management
Background:
- Emergency nursing triage is accurate and reliable.
- The process of using triage scores for bed assignments is not well understood.
- Acuity-arrival order prioritizes patients by acuity, then by arrival time.
Purpose of the Study:
- To investigate how emergency nurses utilize triage scores in bed assignment decisions.
- To examine the factors influencing patient prioritization in emergency departments.
Main Methods:
- Observational study across 6 emergency departments.
- Involved 37 emergency nurses across 18 observation sessions.
- Data collected via questionnaires, data collection tools, and field notes; analyzed using content analysis and descriptive statistics.
Main Results:
- 57.8% of 325 observed bed assignments deviated from acuity-arrival order.
- Prioritization was influenced by institutional norms, patient streaming, and department size.
- Nurses expressed distrust in triage scores, viewing prioritization as a complex, holistic decision.
Conclusions:
- Bed assignments do not consistently follow triage scores or wait times.
- Prioritization involves clinical acuity, safety, logistics, and operational factors.
- Subjective and inconsistent prioritization raises quality, safety, and ethical concerns in emergency practice.
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