Calibrating urgency: Triage decision-making in a pediatric emergency department

Vimla L. Patel, Lily A. Gutnik, Daniel R. Karlin, Martin Pusic

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.

Original languageEnglish (US)
Pages (from-to)503-520
Number of pages18
JournalAdvances in Health Sciences Education
Volume13
Issue number4
DOIs
StatePublished - Oct 1 2008

    Fingerprint

Keywords

  • Clinical guidelines
  • Decision-making
  • Emergency department
  • Nursing education
  • Triage

ASJC Scopus subject areas

  • Education

Cite this