Training for the role of triage in Australasia

Knowledge, Awareness, and Understanding of Pediatric Triage Among Nursing Officers in India: A Multicenter Study

INTRODUCTION

 Triage is crucial in patient screening within emergency departments (EDs) worldwide. It is one of the essential and standard medical practices in many developed countries. However, in India, there is a need for improvement in triage utilization, as it is predominantly performed by resident doctors or medical officers, leading to an uneven distribution of clinical skills among healthcare providers (HCPs). A comprehensive analysis incorporating literature review and data collection revealed that while mandatory screening is conducted in most Indian EDs, the formal implementation of standardized triage protocols remains limited. Like in developed countries, registered nurses or nursing officers (NOs) can be effectively trained and directed to play the role of dedicated triage personnel in EDs of most of the healthcare facilities in India.

METHOD AND MATERIALS

 This study aimed to examine the current state of triage utilization and its impact on the distribution of responsibilities among HCPs in Indian EDs. Through this online survey, the investigators assessed the knowledge and practical understanding of clinical triaging among NOs, working at various hospitals nationwide.

RESULTS

 The participants included 5,029 NOs working in various parts of India, predominantly nursing graduates (82.52%), the majority being employed in government healthcare settings (84.01%) and most having over five years of cumulative working experience in the ED (70.77%). Nurses showed inadequate knowledge and awareness about the Pediatric Assessment Triangle (PAT) used for quick initial evaluation (62.18% among all participants). Concerning the complete triage process applicable, especially in pediatric ED settings, they had even less satisfactory knowledge and understanding, e.g., identifying primary (28.27%) and secondary (22.69%) survey components via focused history and examination, properly using temperature assessment (23.32%) and instant blood glucose level assessment (22.95%) in triage, and knowing various types of internationally accepted triage systems for ED-based health facilities such as the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS) (15.87%). ANOVA and post hoc analysis revealed that the intergroup performance of the study participants with maximum correct responses to the knowledge-determining specified subset of the questionnaire depicts the significantly higher role of graduate nursing degree over diploma such as General Nursing and Midwifery (GNM)/Auxiliary Nursing and Midwifery (ANM) qualification, working in government hospital versus private setup, and ED working experience of >5 years over that of <5 years.

CONCLUSIONS

 Of the participants in the study, 50% were not evaluated for cognitive or psychomotor domains during their assessment examinations. The research illuminated a significant disparity in knowledge and proficiency levels among Indian nurses concerning pediatric triage, especially with the ability to effectively apply the PAT for initial patient evaluations, discern components of primary and secondary surveys, and comprehend various triage systems. This study underscores the importance of comprehensive reform in the Indian healthcare system and teaching curriculum by emphasizing clinical triage training and interprofessional collaboration, and establishing guidelines and regulations to ensure consistent and standardized triage practices across all EDs.

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

BACKGROUND

Triage refers to the process of patient prioritisation in the emergency department (ED). This is based on the severity of the patient's illness and is performed by emergency nurses (ENs). This has a pivotal role in ensuring patient safety and in ensuring that the ED operates smoothly - so continuous and accurate training are essential. As Emergency Nursing has been formally established in Greece since 2019, it is of the uppermost importance that all Greek ENs should be trained in the use of a standardised triage system. The present study aimed to evaluate the effect of triage training of ENs in the use of the Swiss Triage System (STS) after an intervention of one week.

METHODS

The effect of triage training was studied experimentally by comparing performance before and one week after training. A sample of thirty-six ENs from the University Department of Emergency Medicine at AHEPA University Hospital took part. The role of training in triage by the STS was assessed by completing the same self-administered questionnaire before and after a 45-minute e-learning program (presentation video of STS but with simulation scenarios) which was available during the period of a week. The post-training test was taken 2 weeks later, after the training process.

RESULTS

The most promising finding was that there was a significant improvement in the number of correct answers after the training in triage (p<0.001). A significant improvement was also detected (p<0.001) in the questions that tested vigilance in providing safe health services by ENs, whereas there was no significant association between the number of correct answers and years of emergency experience or level of education, - either before or after the intervention.

CONCLUSIONS

Triage training seems to successfully improve effective and efficient triage. To the best of our knowledge, this is the first study that has demonstrated that triage training has a significant positive impact on triage performance by ENs in Greece. It is planned to support these findings by real time studies in an ED.

Development of a Web-Based Korean Triage and Acuity Scale Learning Program for Emergency Department Nurses

The Korean Triage and Acuity Scale is a tool developed to classify severity and urgency of emergency department patients, focusing on their symptoms. Considering the importance of the Korean Triage and Acuity Scale, learning for emergency department nurses who perform the Korean Triage and Acuity Scale must be structured to ensure that the knowledge they gain can be applied to various clinical situations of the emergency department. Moreover, Web-based learning is considered appropriate in this situation. This is a methodological research study that was conducted to develop a Web-based Korean Triage and Acuity Scale learning program for emergency department nurses. The learning program was developed using each of the five phases of the "analysis, design, development, implementation, and evaluation" model, that is, analysis, design, development, implementation, and evaluation. The learning program was composed of 22 cases of emergency situations based on the Korean Triage and Acuity Scale teaching material with an approval from the Korean Triage and Acuity Scale committee in the Korean Society of Emergency Medicine. The developed program was delivered in 4-hour sessions over 4 weeks. Emergency department nurses who were given the Web-based Korean Triage and Acuity Scale learning program showed improvement in work-site transfer and reported satisfactory learning. The findings indicate that the Web-based learning program for nurses can be used as an effective tool that is easily accessible and provides multiple learning opportunities.

Triage in Australian emergency departments: Results of a New South Wales survey

AIM

To describe current models of triage, the preparation and education of triage nurses, and methods of auditing triage practice in New South Wales emergency departments.

BACKGROUND

Triage is a critical component of emergency department practice; affecting patient safety and access to emergency care. Within Australia, triage is an autonomous role predominantly conducted by trained emergency nurses. Patient safety and timely access to emergency care relies upon the experience, education and training of emergency triage nurses. To date, little is known about triage models of care, the preparation and education of triage nurses, and assessment of triage practice and decision accuracy.

METHOD

Descriptive, exploratory study design employing a self-reporting cross-sectional survey of clinical nurse consultants and educators in New South Wales.

RESULTS

The survey results reveal variability in models of triage, and the eligibility, preparation and education requirements of triage nurses; that appear geographically related. Auditing of triage practice was commonly undertaken retrospectively; feedback to triage nurses was infrequent. The survey found evidence of locally developed guidelines directing triage category allocation for specific conditions or symptoms.

CONCLUSION

The purpose of triage is to ensure that the level of emergency care provided is commensurate with clinical urgency. Variability in the preparation, education and evaluation of triage nurses may in and of itself, contribute to poor patient outcomes. Further, workforce size and geography may impede auditing and the provision of feedback, which are critical to improving triage practice and triage nurse performance. It is imperative that the Emergency Triage Education Kit be revised and maintained in tandem with future revisions of the Australasian Triage Scale.

Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study

Objective

This study was aimed to assess knowledge and skills of triage and associated factors among nurses in emergency department of Hawassa University Comprehensive Specialized Hospital, South Ethiopia. Institutional based cross-sectional study design was conducted among 101 nurses from March 1–30, 2018. The data was coded and entered to SPSS version 22.0. Descriptive statistics was done and Chi square test was done to show the association between independent variables and dependent variable.

Results

Among the study participants, 57.4% were female and 87% were in age group of ≤ 30 years. 51.5% had low triage knowledge scores, with the mean score being 9.54 (SD = 2.317), 76.2% perceived their overall triage skill to be at good level, with mean score 95.75 (SD = 9.562). Working experience of study participants (χ² = 15.204, p < .01), Educational level of study participant (χ² = 22.148, p < .01) and triage experience (χ² = 13.638, p < .01) were factors associated with triage knowledge. Working experience (χ² = 7.944, p < .05) and triage experience (χ² = 6.264, p < .05) were factors associated with triage skill.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4062-1) contains supplementary material, which is available to authorized users.

Triage skill and associated factors among emergency nurses in Addis Ababa, Ethiopia 2017: a cross-sectional study

Objective

The aim of this study was to assess levels of triage skill and associated factors among emergency nurses in Addis Ababa, Ethiopia, 2017.

Results

Above half of the participants (52.9%) had a moderate level of triage skill. A strong positive relationship was found between nurses’ level of triage knowledge and skill (r = .68, p .01). Knowledge about triage, educational level and training experience had a significant relationship with triage skill with (B = 1.09, CI (1.41, 1.77), p = .002), (B = − 19.96, CI (− 30.208, − 9.715), p = .001), (B = .55, CI .16, .94), p = .006) respectively. This study revealed that most triage nurses had a moderate level of skills. Therefore, the ministry of health and hospitals should provide training and education to improve triage skill.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3769-8) contains supplementary material, which is available to authorized users.

Atividades do enfermeiro nos sistemas de triagem/classificação de risco nos serviços de urgência: revisão integrativa

Objetivou-se identificar e avaliar as evidências disponíveis na literatura sobre as atividades do enfermeiro na classificação de risco nos serviços de urgência. Realizou-se uma revisão integrativa, com busca nas bases de dados Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrievel System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO). Foram selecionados 22 artigos que atenderam aos critérios de inclusão. Os resultados evidenciaram que as principais atribuições deste profissional são a avaliação do estado de saúde do usuário e a tomada de decisão, processo que necessita de conhecimento clínico e de tempo de experiência. O enfermeiro tem a capacidade de organizar o fluxo dos usuários conforme a prioridade do atendimento e a demanda dos serviços, sendo um profissional de excelência na execução da triagem/classificação de risco nos serviços de urgência.