Triage emergency nurse decision-making: Incidental findings from a focus group study

•Triage nurses negotiate multiple competing system demands when making decision.•Contextual factors result in friction between paramedics and triage nurses.•Administrative initiatives to maintain flow may not align with how nurses triage.•Deescalating potentially disruptive triage line-up situations...

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Bibliographic Details
Published in:International emergency nursing 2020-01, Vol.48, p.100791, Article 100791
Main Authors: Reay, Gudrun, Smith-MacDonald, Lorraine, Then, Karen L., Hall, Marc, Rankin, James A.
Format: Article
Language:English
Subjects:
Clinical decision making
Decision makers
Decision making
Emergency department
Emergency medical care
Emergency services
Fatigue
Focus groups
Nurse led services
Nurses
Paramedics
Qualitative research
Thematic analysis
Triage
Triage nursing
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Summary:•Triage nurses negotiate multiple competing system demands when making decision.•Contextual factors result in friction between paramedics and triage nurses.•Administrative initiatives to maintain flow may not align with how nurses triage.•Deescalating potentially disruptive triage line-up situations requires courage.•Personal capacity including experience and triage fatigue influence triage decisions. Emergency Department (ED) triage decision-making is a complex process. Triage scales are used to determine patient acuity level, however, they do not provide information on how nurses make triage decisions. This focus group study was part of a larger project to develop a psychometrically sound instrument to measure triage decision-making by nurses; the Triage Decision-Making Instrument. We report important incidental findings that emerged during the study that the participants identified as factors impeding triage decision-making. Three focus groups were conducted with 11 triage Registered Nurses. They commented on the instrument items and identified factors that influence triage decision-making. Transcripts were analyzed using thematic analysis. Three powerful inter-related themes emerged central to encumbering triage decision-making: competing systems (pre-hospital versus the ED), fluctuating patient volume resulting in ‘intra-Canadian Triage and Acuity Scale’ triaging, and personal capacity including experience and ‘triage fatigue’. The findings demonstrate how interrelated system factors impede nurses triage decision-making. Triage nurses require support in their role and initiatives are needed to reduce the pressure they feel in relation to resolving system issues. Larger system issues and the capacity of the individual decision-makers must be accounted for within the context of increasing effectiveness and safety of ED triage.
ISSN:1755-599X
1532-9267
1878-013X
DOI:10.1016/j.ienj.2019.100791