Nurse decision making in triage cose assignment: a qualitative descriptive study

Abstract

Given the importance of improving Emergency Department (ED) quality of care and patient satisfaction and safety, analyzing how nurses make decisions in the triage process may help healthcare organizations in developing effective and safe EDs and in supporting healthcare staff. The present study was therefore conducted to explore factors that contribute to nurses' decision-making in the triage process. Two Focus groups with 20 nurses have been conducted and content data analyses performed following a descriptive qualitative approach. Three main aspects tend to affect nurses' decision making in the triage process and therefore influence priority code assignment: the patient's condition (signs and symptoms, risk of adverse clinical evolution, presence of frailty conditions), the organizational setting (patients flow, relationship with medical staff, stressful environment, support from the organization) and the nurse's experience (experience with similar situations, intuition, burden of responsibility). Nurses tend to balance adherence to protocols with appropriate responsiveness of the ED department and tend to seek peer feedback regarding to the priority code assigned. Triage is a complex process, consisting of many factors, resulting from contingent situations that vary continuously. These elements intersect in a process that continuously tends to affect the decision.