An observational study of the emergency triage nursing role in a managed care facility

Introduction A 72-hour observational pilot study was conducted at a large managed-care facility to determine what functions triage nurses fulfilled, how often they fulfilled these functions, and how much time was taken for these functions. Methods Patient arrival times, nursing activities, and patient dispositions were recorded. Activities were classified as either primary or nonprimary, according to defined triage purposes. Two alternating observers collected data continuously for 72 hours, during which they observed 13 triage nurses as they completed their regularly scheduled shifts. All nonprimary functions that occurred while the triage nurses fulfilled primary functions were classified as interruptions. All data were entered into computer software and whole minutes were used for calculating times. Results Nurses provided triage for 466 patients, and 655 telephone calls occurred. Twenty-nine physical triage activities and 26 telephone activities were observed. Telephone functions occupied about 22% of the time. Nonprimary telephone or triage functions interrupted 251 (54%) of all patients who were seen for triage. These interruptions notably increased pretriage waiting times for all patients who were interrupted but were most significant for patients with acuity levels 2 (p < 0.05) and 3 (p < 0.05). Number of interruptions and length of time spent waiting to see the triage nurses were significantly correlated (r = 0.69). Discussion Our study describes a method of evaluating triage nursing activities and suggests that some functions may contribute to delays in physician and nurse access.