Nurses around the world use intuition to determine how sick a patient is before triaging them for treatment, according to new research from the University of East Anglia.
Understanding Triage Acuity Assessment by Emergency Nurses at the Initial Presentation of an Adult Patient: A Qualitative Systematic Review
Highlights • A novel qualitative systematic review of nursing decision-making processes in triage . • Nurses prefer holistic reasoning to assess acuity. • They compare patients to broader environmental circumstances. • Nurses rely on their knowledge and experience to provide context. |
Summary
Background
Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how they make these decisions and why they deviate from classification algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness.
Goals
This qualitative systematic review aimed to understand the decision-making processes that emergency nurses use to make acuity decisions during triage assessment at initial patient presentation.
Methodology
Medline, CINAHL, and Academic Search Complete were systematically searched up to December 15, 2022. Data were analyzed using thematic synthesis. Established themes were reviewed using GRADE-CERQual to assess the certainty of the evidence.
Results
28 studies were included in the review. Analysis of the data uncovered three key themes: holistic reasoning, situational awareness, and informed decision making. Findings show that nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the broader situation in the emergency department.
Conclusions
This review presents new perspectives on nurses’ decision-making processes regarding patient acuity. Nurses collect information about patients holistically before translating that information into acuity scores. These actions are informed by your knowledge and experience; However, the broader situation also affects your decisions. In turn, nurses use interpretations of patients’ acuity to monitor the overall situation.
Comments
The research team also found that nurses’ ability to perform accurate triage is significantly negatively affected by environmental pressures, including workload, staffing, and space. The team says nurses should have access to better work environments and triage training, to enable them to make safe and accurate decisions.
Professor Toby Smith, from the UEA School of Health Sciences, said: “Millions of people around the world attend emergency departments every day. These patients need triage to assess how sick they are and how quickly they need treatment. "We wanted to better understand how nurses make decisions when triaging patients."
Dr Marie McGee, also from the UEA Faculty of Health Sciences, added: "Understanding nurses’ decision-making in the initial assessment of patient acuity is crucial as it informs how needs are prioritised. of patients to receive fast, effective and safe care to improve their health. results."
The research team studied data from 28 previously published articles and took into account the views of more than 373 nurses from around the world, including the UK, US and Australia.
Postgraduate researcher Hugh Gorick, also from the UEA Faculty of Health Sciences, said: “We found that nurses value practical assessments that focus on the individual to assess patients over standardized assessment tools. “For example, nurses are more likely to look at the patient as a whole , rather than simply focusing on assessing a particular symptom. This could include taking into account how much the symptoms affect them, what their previous medical history is, and even how sick they look.
“They trust intuition , but this is not necessarily negative because they use it according to their experience and clinical evaluations. Evidence from other studies shows that their clinical judgment is as accurate as standardized tools for identifying how sick a patient is.
“Their decision-making process is based on a combination of teaching knowledge and work experience. However, nurses also expressed their opinion that the triage training currently available is insufficient for their needs.
“Our findings not only explore how nurses make these triage decisions, but also show a demand for better training, as well as the need to ensure safe triage environments. “These represent important considerations for both triage nurses and emergency department managers.”
The study was led by UEA researchers, with a review team made up of nurses and doctors from the University Hospital of Norfolk & Norwich.
Final message
This review provides important insight into the processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation.
A key finding of this review is that nurses prefer holistic assessment over triage algorithms, believing they provide comprehensive, individualized insights into patients’ acuity. This important finding not only sheds light on why nurses go beyond triage algorithms, but also highlights potential areas of focus for future research.
Our findings discuss how assessing patients’ acuity is only part of the assessment process. They explored how nurses compare their patients to other patients and the broader situation in the emergency department as part of their assessments, while also considering environmental pressures. An important finding of this review is that nurses modify their assessments to mitigate negative environmental influences, potentially at the expense of accurate classification.
We also considered what informs nurses’ evaluations, finding that nurses rely on a combination of knowledge and experience supported by personal characteristics. The findings also highlighted that nurses feel that the training currently available for triage is insufficient, a significant finding with implications for educators and researchers.
By exploring these processes, we better understand how nurses make acuity decisions. This means we can make improvements to classification systems that work with nurses’ processes, increasing acceptability and effectiveness, and resulting in better patient outcomes.
Reference : Hugh Gorick, Marie McGee, Gemma Wilson, Emma Williams, Jaimik Patel, Anna Zonato, Wilfred Ayodele, Sabina Shams, Luca Di Battista, Toby O. Smith. Understanding triage assessment of acuity by emergency nurses at initial adult patient presentation: A qualitative systematic review . International Emergency Nursing, Volume 71, 2023, 101334, ISSN 1755-599X, https://doi.org/10.1016/j.ienj.2023.101334 .
