Retrospective Audit of Triage of Acute Traumatic Shoulder Dislocation by Emergency Nurses

Abstract

Acute traumatic shoulder dislocation (ATSD) is a relatively common presentation to the emergency department. Research into nurse-led triage shows emergency nurses to be accurate at identifying patients with bony injuries and follow protocols to expedite appropriate care. The aim of this study was to assess the quality of triage decisions made by emergency nursing staff in cases of confirmed ATSD, in an emergency department in the United Kingdom. A retrospective audit was undertaken on patients with ATSD for 12 months (August 2006-August 2007). The nursing triage sheet and the clinical record forms were used to obtain data detailing the entire patient journey from arrival in the department to discharge. Emergency nurses were less likely to identify ATSD at triage than their physician colleagues during their initial clinical assessment (OR 0.06; 99% CI 0.014-0.272). Failure to identify ATSD at triage affected the efficiency of the remaining patient journey. A learning need for nursing staff in the initial assessment and identification of ATSD has been identified. The King's Mill Hospital's integrated care pathway for ATSD has been developed in response to the findings of this study, designed to aid diagnosis at triage and expedite patients through the stages of their ED journey. Significant areas for improvement have been identified in the initial assessment and management of patients with ATSD presenting at triage in the emergency department. The impact of the King's Mill Hospital's integrated care pathway on the quality of triage in ATSD requires further assessment.