The effect of emergency department nurse experience on triage decision making
Tamari Levis-Elmelech, Dagan Schwartz, Yuval Bitan
Abstract
This study retrospectively examined patient records from the Emergency Department to investigate how nurse experience in this department affected triage decisions. Triage is a crucial aspect of Emergency Department care, and studies have found that experience affects clinical decision making. The Emergency Severity Index (ESI) is a structured, well validated and widely-used tool that aims to assist triage decision making. ESI classification was compared to patients’ Emergency Department disposition at a large tertiary hospital to measure decision-making accuracy. Decisions were classified into four types: successful identification of high-urgency patients, successful identification of low-urgency patients, misidentification of high-urgency patients (under-triage), and misidentification of low-urgency patient (over-triage). Analysis of 18,321 patient records demonstrated a correlation between nurses’ experience in the Emergency Department and their decisions. Pearson residuals analysis revealed that less-experienced nurses were more successful in identifying high-urgency patients, but tended to misclassify low-urgency ones (over-triage). In contrast, experienced nurses were more successful in identifying low-urgency patients, but misclassified more high-urgency ones (under-triage). Nurse experience is an important factor in decision making, even when using a highly-structured tool such as the ESI. The tendency of more-experienced nurses to under-triage and for less experienced nurses to over-triage highlights the need to improve triage decision making. Raising awareness and providing focused feedback and continuing education may improve triage accuracy by assisting nurses to fine-tune their behavior and decision making.