Date of Graduation

Fall 12-15-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project


Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will be provided to all nurses. Additional posters containing the algorithm were posted in the department specifically in the triage area.

Measures: Random data collection from January, February, March and April 2023 were used as baseline mistriage rates. After the retraining and educational material distribution, charts from October 16, 2023 to November 16, 2023 were audited to assess if mistriage rates improved. Pre and post surveys assessing the staffs’ comfortability with the ESI were also used to evaluate improvements with triage accuracy.

Results: Mistriage rates were found to be occurring at a rate of 23% at baseline which was 400 charts from January to April 2023. The rate of mistriage improved to 10.5% for one month following the final ESI retraining.

Conclusion: Triage accuracy rates improved for one month immediately following the intervention. Further monitoring will be necessary to ensure improved rates are sustained.

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