Errors in nurse-led triage: An observational study
Section snippets
Background
Triage is the first assessment and sorting process used to prioritize patients arriving in emergency departments. It is a particularly vulnerable point in patient evaluation, as triage nurses must gauge patients’ acuity levels, the mortality threats their conditions entail, and their anticipated resource needs. However, the need for accurate prioritization is impeded by high demand for emergency care (Rasouli et al., 2019), frequent emergency department overcrowding (Di Somma et al., 2015), and
Study design
We conducted a retrospective observational (chart review) study.
Sample and setting
This study was conducted in the emergency department of Merano Hospital (SABES-ASDAA) in Northern Italy (70,000 emergency department visits per year, 300 acute-care beds). Since 2013, Merano Hospital’s emergency department triage has been standardized according to the Manchester Triage System method. Every shift's (morning/afternoon) triage is performed by two triage nurses; only one is present during night shifts. With certain
Characteristics of the patients, emergency department work environment and triage nurses
The characteristics of the patient sample, the emergency department work environment and the triage nurses are summarized in Table 1. The median patient age was 58, with one-third having at least one chronic condition. Nearly 60% accessed the emergency department during morning shifts; 7% revisited the emergency department < 72 h, 10% of these presenting with high severity (orange or red code). Regarding the emergency department work environment, a median of 20 patients were triaged before the
Discussion
This study provided primary evidence on nurse-led triage errors, their contributing factors and their consequences for patients. In one-sixth of the randomly selected patient files, presentational flow charts and/or specific discriminators were not correctly selected, and/or priority levels not correctly assigned by triage nurses. Factors contributing to triage errors related to patient, emergency department work environment and individual nurse characteristics. Patients with triage errors
Conclusions
With this retrospective study we provided primary evidence on the frequency, contributing factors and outcomes of triage errors. In one-sixth of the randomly selected patients’ files, presentational flow charts and/or specific discriminators were not correctly selected, and/or priority levels not correctly assigned by triage nurses. Factors contributing to triage errors related to patient, emergency department work environment and individual nurse characteristics. Patients with triage errors
CRediT authorship contribution statement
Dietmar Ausserhofer: Methodology, Writing - review & editing, Writing - original draft. Arian Zaboli: Conceptualization, Data curation, Writing - original draft, Writing - review & editing. Norbert Pfeifer: Methodology, Writing - review & editing. Pasquale Solazzo: Conceptualization, Data curation, Writing - review & editing. Gabriele Magnarelli: Conceptualization, Data curation, Writing - review & editing. Tania Marsoner: Conceptualization, Data curation, Writing - review & editing. Marianne
Conflict of Interest
None.
Acknowledgments
We sincerely thank the nursing management and the triage nurses at the emergency department of [BLINDED] for their support and participation in this study.
Funding
None Declared.
Ethical Approval
None Declared.
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