Implementation of a Nursing Triage Order to Improve Utilization of Rapid Diagnostic Testing for Chlamydia and Gonorrhea in the Emergency Department

Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis

“…We identified 23 973 relevant citations from database search, of which 40 met the inclusion criteria17–19 25 27–62 (44 study reports). The study selection process is reported using the PRISMA study flow chart (figure 1).…”

“…Included studies were full-length journal articles17–19 25 27–44 46–48 50 51 55 57 58 60 (n=31; 77.5%), abstracts (n=8)45 49 52–54 56 59 62 or thesis (n=1)61 published from 1993 to 2020. More than half were conducted in North America17 18 25 30 31 33–35 38–41 48 50 51 53 54 57 59 61 62 (n=21; 52.5%), and the rest were conducted in Europe19 27–29 36 37 42 44 47 52 56 (n=11; 27.5%), Asia55 58 60 (n=3; 7.5%), Australia32 43 (n=2; 5%), Middle East45 46 (n=2; 5%) or the location was not reported49 (n=1; 2.5%) (table 1).…”

“…Included studies were full-length journal articles17–19 25 27–44 46–48 50 51 55 57 58 60 (n=31; 77.5%), abstracts (n=8)45 49 52–54 56 59 62 or thesis (n=1)61 published from 1993 to 2020. More than half were conducted in North America17 18 25 30 31 33–35 38–41 48 50 51 53 54 57 59 61 62 (n=21; 52.5%), and the rest were conducted in Europe19 27–29 36 37 42 44 47 52 56 (n=11; 27.5%), Asia55 58 60 (n=3; 7.5%), Australia32 43 (n=2; 5%), Middle East45 46 (n=2; 5%) or the location was not reported49 (n=1; 2.5%) (table 1). Most studies used a pre–post intervention design17 18 25 30–34 36–39 61 (n=13; 32.5%) and the remaining were characterised as randomised controlled trials (RCT)41 42 44 45 50 51 55–57 59 (n=10; 25%), observational retrospective cohort studies19 28 40 47 53 54 60 62 (n=8, 20%), controlled before and after studies (CBA)27 35 46 52 (n=4; 10%), quasi-randomised trials43 (n=1; 2.5%) observational prospective cohort studies48 49 58 (n=3; 7.5%) or cross-sectional observational studies29 (n=1; 2.5%).…”

“…The median duration of intervention reported among included studies was 6 months (range: 2.5 days to 17 months). Studies were mostly conducted in urban EDs18 19 25 28 30–33 35–38 40–46 48–51 54 57–59 62 (n=28; 70%), one (2.5%) was conducted in a rural ED and two27 29 (5%) were conducted in a combination of urban and rural facilities; nine17 34 47 52 53 55 56 60 61 (22.5%) studies did not report their setting. We classified the EDs reported in the included studies into paediatric EDs (age <18)18 45 50 53 57 60 (n=6; 15%), mixed EDs seeing both adults and children17 32 48 52 55 58 (n=6; 15%) and adult only EDs30 33 41 43 46 (n=5; 12.5%), depending on the age of the population that the EDs served.…”

“…While the precise role of the NPs, GPs or nurses given increased authority (all referred to as primary healthcare professionals (PHCPs)) in an ED is unclear, they may provide potential benefits to improve ED times and outcomes. Studies have reported the following roles of the PHCPs at ED triage: (1) GP either triaging (seeing and treating, streaming) or supervising triage27–29; (2) NP either alone or working alongside a triage nurse (ordering investigations, streaming, seeing and treating, or assessing patients and discharging/redirecting)17–19 25 30–39; (3) Triage nurse with increased authority given extra capacities outside of their usual scope of practice to order investigations for patients before streaming to the ED MD 40–62. Although, many primary research studies have investigated the impact of PHCPs19 32 36 37 40 63 64 at triage on ED patient flow, to the best of our knowledge, there are no systematic reviews that have summarised evidence from these studies.…”