Triage: an investigation of the process and potential vulnerabilities

Abstract

Aim: To explore and describe the triage process in the Emergency Department to identify problems and potential vulnerabilities that may affect the triage process.

Background: Triage is the first step in the patient journey in the Emergency Department and is often the front line in reducing the potential for errors and mistakes.

Design: A fieldwork study to provide an in-depth appreciation and understanding of the triage process.

Methods: Fieldwork included unstructured observer-only observation, field notes, informal and formal interviews that were conducted over the months of June, July and August 2012. Over 170 hours of observation were performed covering day, evening and night shifts, 7 days of the week. Sixty episodes of triage were observed; 31 informal interviews and 14 formal interviews were completed. Thematic analysis was used.

Findings: Three themes were identified from the analysis of the data and included: 'negotiating patient flow and care delivery through the Emergency Department'; 'interdisciplinary team communicating and collaborating to provide appropriate and safe care to patients'; and 'varying levels of competence of the triage nurse'. In these themes, vulnerabilities and problems described included over and under triage, extended time to triage assessment, triage errors, multiple patients arriving simultaneously, emergency department and hospital overcrowding.

Conclusion: Findings suggest that vulnerabilities in the triage process may cause disruptions to patient flow and compromise care, thus potentially impacting nurses' ability to provide safe and effective care.

Keywords: emergency; emergency nursing; errors; fieldwork; nurses; patient flow; patient safety; thematic analysis; triage.