Date of Graduation

Fall 12-15-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Sierra Dias McEvoy

Second Advisor

Jennifer Zesati

Abstract

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. Supplemental materials, including posters and badge reference cards that outlined the ESI algorithm were created. In the pre-survey, nurses often felt comfortable assigning ESI levels 1 through 5, which increased to mainly always in the post-survey. Regarding the department's overall triage ability, the pre-survey revealed a perception of correct triaging only sometimes, while the post-survey showed a new majority consensus of triaging accurately as often. Another audit of 400 random ED visits (October 16th to November 16th) showed the mistriage rate dropped from 23% (pre-data collection) to 10.5%, and under- and over-triage rates improved, decreasing to 6.25% and 4.25%, respectively. Despite a brief post-data collection timeframe, the educational trainings and supplemental materials showed initial success in reducing triage inaccuracies. This hints at the potential to further lower the mistriage rate to below 10% with consistent application of the interventions. Include suggesting the implementation of an annual educational training, adopting a flipped classroom style, incorporating the use of an AI model, or a combination of these approaches.

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