How to improve the Triage: A dashboard to assess the quality of nurses’ decision-making

Abstract

This paper presents a dashboard for assessing the quality of Triage decision-making process in the assignment of the priority code to patients arriving at an emergency department. The quality is assessed through performance indexes aimed at measuring both the nurses’ accuracy and the presence of nurses’ shared behavior in the Triage assignment process. The theoretical perspective of the cognitive heuristic, that is a cognitive shortcut strategy to make decisions, is the framework to design performance indexes of the dashboard. The dashboard has been tested in two Emergency Departments. We gather the data input through the submission to 54 nurses of a questionnaire, simulating 25 patients’ scenarios. The dashboard reveals a disparity between nurses in priority level assignment. This disparity depends on nurses’ capacity in disregarding some information and in considering the right cue. We find the presence of sharing behaviors and inclination to over or under assessment by nurses. This performance analysis, integrated with the nurses’ reasoning in assigning the priority code, can address the management in designing improvement actions at individual level and at the organizational one. In addition, the application to two Emergency Department confirms the influence of organizational aspects in the individual decision process.

Analysis of Factors Related to The Accuracy of Triage Assessment at The Emergency Room

“…Unexpectedly, nurses' work experience was not shown to have a significant impact on the accuracy of triage assessments. This contrasts with previous findings from (Cannavacciuolo et al, 2021;Levis-Elmelech et al, 2022) study, which showed that experience can contribute to more accurate decisionmaking in triage assessments.…”

The first positive evidence that training improves triage decisions in Greece: evidence from emergency nurses at an Academic Tertiary Care Emergency Department

“…The development and improvement of triage decision-making skills can be addressed through different educational strategies, supported by clinical experience, and this should serve to improve patient flow in the ED [ 10 – 12 ]. Simulation seems to be more effective than simple lectures in training nurses in triage [ 13 , 14 ]. Nevertheless, a systematic review was held in Iran from 2010 to 2020 to identify the best method for teaching triage and this concluded that a mixed learning approach (workshop, lectures, simulation, and games) was the most effective triage training [ 15 ].…”