Abstract
Poster presentation
Session B presented Monday, September 30, 11:30 am-12:30 pm
Purpose: Emergency departments use Emergency Severity Index (ESI) in triage to prioritize at-risk patients and predict resource utilization. We observed that ESIs in our department varied greatly depending on triage nurse personality, initial triage training, and experience. We identified an opportunity to lower variability of ESIs through education with real life case studies to achieve better prioritization, patient safety, and staff utilization.
Design: We used an action research design to both characterize the problem of high variability of ESI levels among our triage nurses while providing educational case studies to remedy the problem.
Setting: Our Level 1 suburban Emergency Department has a mix of triage trained nurses - some with more than 20 years of experience and others with as little as one.
Participants/Subjects: Patient cases were selected for case studies based on chief complaints and presenting problems that tended to cause the most variation in assigned ESI levels. Triage nurses were randomly asked to contribute to weekly case studies and all staff received the finished educational case studies to review.
Methods: We validated the initial variability of our ESI triage process with a ten-question survey taken from standardized questions within the AHRQ website. Immediately following the survey, all participants were provided the correct responses with justification. We then selected real-life patient cases and created 12 ESI case studies. The case studies included initial patient presentation, vital signs, staff-assigned ESIs and a discussion that included references to AHRQ’s ESI standards, other pertinent research, and the outcome of the case. The case studies intentionally did not provide a correct answer but rather were designed to reinforce the national standards and contribute to nurses’ development of critical thinking. Additionally, our Unit Based Council, in collaboration with our medical director and nursing leadership, implemented ESI department norms for a variety of common chief complaints, specifically reducing ESI variability for our stroke alerts and intubated patients, aligning with the national standards.
Results/Outcomes: From our initial survey, we did not have a single case with 100% agreement and the responses only agreed with the AHRQ answers 64% of the time. We under-triaged 55% of ESI 1s, indicating this is an area to target our case studies. In early 2019, we will assess the effectiveness of this education with another ten-question survey. Although we do not yet have objective data, staff do subjectively state that the variability of ESIs has decreased and that our process is now more in-line with national standards. Based on early evidence and observation of our triage nurses, we expect our ESIs to agree with the national standards greater than 80% of time post-intervention.
Implications: Developing real-life case studies from actual patients seen in our department and combining them with national standards from the AHRQ ESI handbook in weekly educational emails reduced ESI variability among triage nurses achieving safer prioritization and more effective use of resources. This low cost educational intervention could be useful to any nursing leadership seeking to further develop their triage nurses and reduce ESI variability.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Triage, ESI, Education
Recommended Citation
Beyer, Corinna and Zembles, Shawn, "Reducing variability of triage levels using real-life case studies" (2020). General Submissions: Presenations (Oral and Poster). 138.
https://www.sigmarepository.org/gen_sub_presentations/2019/posters/138
Conference Name
Emergency Nursing 2019
Conference Host
Emergency Nurses Association
Conference Location
Austin, Texas, USA
Conference Year
2019
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Reducing variability of triage levels using real-life case studies
Austin, Texas, USA
Poster presentation
Session B presented Monday, September 30, 11:30 am-12:30 pm
Purpose: Emergency departments use Emergency Severity Index (ESI) in triage to prioritize at-risk patients and predict resource utilization. We observed that ESIs in our department varied greatly depending on triage nurse personality, initial triage training, and experience. We identified an opportunity to lower variability of ESIs through education with real life case studies to achieve better prioritization, patient safety, and staff utilization.
Design: We used an action research design to both characterize the problem of high variability of ESI levels among our triage nurses while providing educational case studies to remedy the problem.
Setting: Our Level 1 suburban Emergency Department has a mix of triage trained nurses - some with more than 20 years of experience and others with as little as one.
Participants/Subjects: Patient cases were selected for case studies based on chief complaints and presenting problems that tended to cause the most variation in assigned ESI levels. Triage nurses were randomly asked to contribute to weekly case studies and all staff received the finished educational case studies to review.
Methods: We validated the initial variability of our ESI triage process with a ten-question survey taken from standardized questions within the AHRQ website. Immediately following the survey, all participants were provided the correct responses with justification. We then selected real-life patient cases and created 12 ESI case studies. The case studies included initial patient presentation, vital signs, staff-assigned ESIs and a discussion that included references to AHRQ’s ESI standards, other pertinent research, and the outcome of the case. The case studies intentionally did not provide a correct answer but rather were designed to reinforce the national standards and contribute to nurses’ development of critical thinking. Additionally, our Unit Based Council, in collaboration with our medical director and nursing leadership, implemented ESI department norms for a variety of common chief complaints, specifically reducing ESI variability for our stroke alerts and intubated patients, aligning with the national standards.
Results/Outcomes: From our initial survey, we did not have a single case with 100% agreement and the responses only agreed with the AHRQ answers 64% of the time. We under-triaged 55% of ESI 1s, indicating this is an area to target our case studies. In early 2019, we will assess the effectiveness of this education with another ten-question survey. Although we do not yet have objective data, staff do subjectively state that the variability of ESIs has decreased and that our process is now more in-line with national standards. Based on early evidence and observation of our triage nurses, we expect our ESIs to agree with the national standards greater than 80% of time post-intervention.
Implications: Developing real-life case studies from actual patients seen in our department and combining them with national standards from the AHRQ ESI handbook in weekly educational emails reduced ESI variability among triage nurses achieving safer prioritization and more effective use of resources. This low cost educational intervention could be useful to any nursing leadership seeking to further develop their triage nurses and reduce ESI variability.