The Right Decision When Time Counts: The Complexities of Triage

Purpose: Accurate triage decisions in the Emergency Department can reduce mortality and morbidity, yet data indicate that accuracy rates are low and delays in patient care are high. The current economic downturn is associated with more people seeking primary care from Emergency Departments that ever before leading to overcrowding. ED overcrowding means that the triage nurse's role in sorting out who needs urgent care and who can wait is more pressing than ever before. Therefore, the purpose of this study is to document the skills necessary for triage nurses so that interventions can be developed to improve accuracy.Design: A qualitative study design was used to reveal the knowledge and skills embedded in the day-to-day practice of triage nurses.Setting: Emergency nurses in the Southeast who had triaged in the past twelve months were invited to be interviewed about their triage experiences. Approval for this study was obtained from the university's institutional review board.Participants: Nurses with a minimum of 12 months experience are being recruited via an online social networking site with an invitation to be interviewed about ED triage. The sample consists of seven female registered nurses to date. Four nurses are Caucasian; the remainder are African American, Asian, and Hispanic. Experience in emergency nursing ranges from 3 to 15 years with a mean of 9 (SD +4.68) years and a mean age of 40 years (SD +8.10).Methods: Using a phenomenological method, the experiences of triage are being explored by conducting semi-structured interviews. The initial interview question is, "Tell me about patients you have triaged". Digitally recorded interviews are being transcribed verbatim and participants are confirming the accuracy of content. A process of coding, comparing, categorizing, and identifying themes is being used while interviewing continues creating a constant comparative analysis.Results/Outcomes: Preliminary findings indicate that accurate triage is very complex and requires the advanced skills typically seen in proficient or expert nursing practice. These skills involve immediate recognition of various conditions that nurses have identified numerous times such as diabetic emergencies, STEMI, or sepsis. When immediate recognition of the problem does not occur, the triage nurse uses expert skills to elicit a more detailed history so that vague yet salient symptoms can be grouped together to create a pattern. Eliciting this detailed history is being labeled "getting to know the patient". Without exception thus far, "getting to know the patient" is associated with how the nurse "connects" with the patient and seems to feel responsible for the patientÆs immediate health outcomes.Implications: Understanding the experiences of triage nurses is leading to strategies to improve practice and the accuracy of the triage process. In addition, this understanding will assist in directing further research into accuracy of triage decisions which is expected to improve patient outcomes.