Regular Article

Momentary fitting in a fluid environment: A grounded theory of triage nurse decision making

“…In order to extend the understanding of factors that may influence triage DM the effect of education and experience have been investigated. In an Australian survey of triage RNs (n = 31) using a questionnaire consisting of 10 patient vignettes, it was found that, midwifery qualifications, a Bachelor's degree, or a graduate diploma in nursing correlated positively with increased triage accuracy (Considine et al, 2001). Specialty education in emergency nursing or critical care nursing was not associated with increased triage accuracy.…”

“…The importance of triage acuity scales is not disputed by the researcher, however, it is important to recognize and acknowledge that triage acuity scores are not always accurate (Atzema, Austin, Tu, & Schull, 2009;Considine, Ung, & Thomas, 2001;Göransson, Ehrenberg, Marklund, & Ehnfors, 2006). In studies of five level triage scales, where the expected acuity score, as assigned by an expert panel, was compared with the actual acuity score assigned to patient vignettes by triage RNs, accuracy was found to be between 58-64% (Bergeron et al, 2004;Considine, LeVasseur, & Villanueva, 2004;Considine et al, 2001;Göransson et al, 2006). Overtriaging occurs when a patient is assigned to a higher category than clinically indicated; this can divert resources away from other patients who are more in need of attention (Considine et al, 2000).…”

“…Conversely, under-triaging is assigning the patient to a lower category than clinically indicated and may delay necessary interventions (Considine et al, 2000;Gerdtz & Bucknall, 2001). The decisions made by the triage RN have implications for patient safety, morbidity, mortality (Cioffi, 1998;Considine et al, 2001;Croskerry, 2002) and the distribution of the workload in the ED. The consequences of inaccurate triage scores are magnified in the context of ED overcrowding.…”

“…Specialty education in emergency nursing or critical care nursing was not associated with increased triage accuracy. Considine et al (2001) suggested that midwifery nursing involves a high degree of autonomous DM and concluded that simply imparting more knowledge about a specialist field may not be an adequate educational strategy and that, instead, education in DM and problem solving is needed.…”

“…It is therefore difficult to draw any conclusions from the results of their study. The conclusion made by Considine et al (2001) that increased education in DM may increase accuracy in triage DM needs to be further explored as to the type of education and delivery mode provided.…”