ABSTRACT
Background: Triage is the process by which emergency departments (EDs) sort patients presenting for medical treatment. The Australasian Triage Scale, validated to measure urgency, answers the question 'This patient should wait for medical assessment and treatment no longer than[horizontal ellipsis]' Multiple patients may present within short time frames, and some will have conditions that have outcomes directly related to timeliness of treatment such as stroke, sepsis and myocardial infarction. The safety of patients within the ED is thus directly related to the triage system. This project aimed to compare current triage practice within a metropolitan ED with evidence-based practice guidelines produced by the Australasian College for Emergency Medicine and College of Emergency Nurses Australasia.
Methods: The clinical audit project was undertaken in an ED in a large metropolitan hospital. Two hundred episodes of triage were audited, 100 in the preimplementation and 100 in the postimplementation phase. Current practice was compared with triage guidelines, barriers to adherence to evidence-based practice identified, and interventions were planned and implemented to address these. The audits of practice focused on five key areas and were assessed against 12 criteria: arrival and triage, documentation, compliance with policy, communication, and triage staff.
Results: Overall five criteria showed improvement, with reassessment of patients waiting for treatment, and the time taken for each triage episode achieving the greatest amount of improvement. Four criteria showed no improvement or a decline, and two achieved 100% adherence in both audits.
Discussion: The project sought to undertake a clinical audit of triage practice to evaluate the adherence of practice to evidence-based guidelines. The project has provided strong support for the implementation of a formal nursing role to support the care of waiting room patients, and act as a second triage nurse during periods of high activity. The physical triage environment has been identified as a barrier to optimal adherence to evidence-based practice guidelines. Using effective communication to manage the waiting experience of patients can have positive benefits for both patients and staff.
What is known about the topic:
* Triage is the first point of contact when a person arrives at an ED, and at this point the urgency of their condition is determined.
* Triage represents an area of high risk in emergency nursing practice as treatment and allocation decisions must be made based upon limited data under time pressured conditions.
* An efficient triage process is crucial to the safety of patients accessing the ED.
What does this article add:
* The physical layout of the ED may act as a barrier or enabler to meeting evidence-based practice guidelines.
* Development of audit criteria followed by an audit of clinical practice can lead to successful evaluation and implementation of ED triage processes to align with best practice recommendations.
* Triage must be resourced with the appropriate staffing levels to be able to undertake all duties recommended within the guidelines.