Effect of triage training on the knowledge application and practice improvement among the practicing nurses of the emergency departments of the National Referral Hospitals, 2018; a pre-post study in Asmara, Eritrea

Abstract

Background Triage starts at the front door of the Emergency Department (ED), and repeatedly performed by the responsible duty nurses with the aim of facilitating a timely and appropriate treatment of patients. A triage system called the Orotta Triage System was implemented in the emergency settings of the selected hospitals in 2006, with the emergency nurses trained to triage using the system. Since the introduction, a majority of nurses have been replaced by new untrained nurses. This study was conducted to assess the impact of an educational intervention on the triage nurses knowledge and performance. Methods A single group pre-posttest study design was performed in the adult EDs of the National Referral Eritrean Referral Hospitals, from January to July of 2018. All staff members in the ED were involved. Data collection tools utilized were, a self-administered knowledge assessing questionnaire and a practice observation checklist. Analysis was done in SPSS (version 22) using repeated measures ANOVA. Statistical significance level was set at P < 0.05. Results The mean knowledge scores at Time 1(prior to the intervention), Time 2 (following the intervention) and Time 3 (three month follow up) were 6.23 (SD = 2.29), 10.55 (SD = 1.79), and 9.39(SD = 2.67) respectively. During the pre-intervention phase, only one (3%) nurse was determined to have adequate knowledge. Two days post training (immediate post-intervention), the percentage possessing adequate knowledge increased to 39% but dropped back to 19% three months later. Mean knowledge difference scores (95% CI) of immediate post and pre-intervention (Diff. = 4.32, 1 95%CI: 3.08–5.56), three months later and pre-intervention (Diff. = 3.16, 95%CI: 1.71–4.62) and immediate post and three months later (Diff. = 1.16, 95%CI: 0.12–2.20) were found to be statistically significant. The median score of appropriate triage practice at pre-intervention (Md = 6, IQR = 3) was not significantly different (p = 0.053) from that at post-intervention (Md = 8, IQR = 5). Conclusion The level of triage knowledge and appropriate application was low among the emergency nurses prior to training. The training provided an initial improvement in knowledge, but no significant improvement in triage nursing performance. To optimize ED triage performance, appropriate, timely in-service training is required to ensure new staff are educated and experienced staff have their knowledge and skills refreshed.

The correlation between nurses' knowledge of triage and the accuracy of triage level interpretation in the emergency department

“…11 This indicates that the longer the tenure, the higher the level of cognitive maturity an individual possesses, thereby leading to an increase in the acquired knowledge. [12][13][14] Based on this research, the majority of nurses in interpreting triage levels fall within the appropriate triage category, accounting for 68.3 %. The results of this research also indicate that there are still nurses with triage level application falling within the under triage and over triage categories, amounting to 31.7 %.…”

Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal

“…Despite the HCWs’ lack of training regarding triage, they were still able to work efficiently. However, providing comprehensive training can greatly improve communication and collaboration among HCWs [ 34 ]. Training was found to improve the knowledge and implementation of a triage system in ED care in Iran [ 35 ].…”

The Effectiveness and Relevance of the Canadian Triage System at Times of Overcrowding in the Emergency Department of a Private Tertiary Hospital: A United Arab Emirates (UAE) Study

“…This stresses the importance of staff education for a successful triage system. Knowledge degradation over time also emphasises the incorporation of regular triage training and supervision programs [13,14]. Factual knowledge is crucial in making triage decisions and, as a result, improving patient outcomes [15][16][17][18].…”