Triage Research Articles

Nurses' experiences of using a computer-based triage decision support system in the emergency department.

Emergency department triage is a vital and complex decision-making process. There is limited knowledge about nurses' experiences with triage decision support systems in emergency departments. This study was conducted to examine nurses' experiences with a computer-based triage decision support system in the emergency department. This is a qualitative and phenomenological study. Data were collected through interviews from 14 triage nurses who used a triage decision support system in the emergency department of a university hospital. The nurses were recruited for semi-structured interviews. All interviews were recorded on a voice recorder and then transcribed. Data were analysed with the inductive content analysis method. The interviewer asked comprehensive questions about the nurses' experiences with the triage decision support system. Three main and 11 sub-themes were elicited as a result of the analysis of the in-depth interviews: (a) the facilitating the triage decision theme, which included help in case of a dilemma, team collaboration, monitoring/supervision, and error reduction sub-themes; (b) the contribution to professionalism theme, which included ease of learning and teaching triage, professional autonomy, creating a database, and evidence-based practice sub-themes; (c) the areas that need improvement theme, which included reducing screen clicks, the effect of the hospital automation system performance, and clinical descriptors not included in the algorithm sub-themes. Triage nurses stated that the decision support system was beneficial and facilitated decision-making. The decision support system enabled triage nurses to make their own decisions using their clinical knowledge and experience, without a restriction on their professional autonomy, and this was perceived positively. It was emphasized that this system could be a support tool in educating nurses new to triage. However, nurses stated that the pace of the decision support system was affected by the performance of the hospital automation system and that the large number of steps used for electing items caused a waste of time. They also added that these were technical areas that needed improvement. The study provides important data that will help healthcare organizations and professionals better understand the emergency department nurse triage decision support system and gain a versatile, comprehensive, and general understanding.

Abstract TP62: Stroke Triage Checklist Decreases Door to Treatment

Background and Issue: Studies have shown that patients who arrive at the Emergency Department (ED) by privately operated vehicle (POV) vs. an ambulance have longer door to needle times. At a comprehensive stroke center, patients who arrived by POV experienced longer times from arrival to activation and door to needle than those arriving to the ED by ambulance. Purpose: To implement a standardized objective assessment triage checklist and evaluate its effectiveness of decreasing arrival to activation and door to needle times. Methods: This quality improvement (QI) project was guided by PDSA methodology. In 02.2023, a stroke nurse champion QI team was formed. Barriers to timely treatment were identified through the use of case timelines and a stroke nurse champion focus group. Patients arriving by POV and treated with a thrombolytic also had low NIHSS (1-4). During root cause analysis, triage nurses expressed a lack of confidence in calling a stroke alert for patients with mild symptoms. To address this barrier, a structured triage checklist was adapted to include the B.E.F.A.S.T. acronym, symptoms easily missed (e.g., difficulty walking, dizziness, headache), posterior stroke symptoms (e.g., diplopia, dysphagia), and a note to prompt activation from the triage room. The checklist was implemented on 04.15.2023. Data collected included patients who arrived by POV and were administered a thrombolytic. Door to alert and door to needle times were derived from a quality database and analyzed pre (01.2023-03.2023)and post implementation (05.2023-07.2023). Results: When comparing pre and post implementation data, there was a 5 min decrease in door to activation time (n=4, 10 min vs. n=3, 5 min) and a 23 min decrease (n=4, 58 min vs. n=3, 35 min) in door to needle time in patients who arrived by POV and received a thrombolytic. All patients treated with a thrombolytic in the ED, regardless of mode of arrival, saw a 26 min reduction in door to needle during this time period (n=15, 69 min vs. n=17, 43 min). Conclusion: Use of a standardized and objective triage checklist empowered nurses to activate a stroke alert prior to receiving provider input on patients arriving by POV with mild symptoms. Enabling quick allocation of resources to expedite thrombolytic administration.

Reliability and Accuracy of the Pediatric Swiss Emergency Triage Scale-the SETSped Study.

The Swiss Emergency Triage Scale (SETS) is an adult triage tool used in several emergency departments. It has been recently adapted to the pediatric population but, before advocating for its use, performance assessment of this tool is needed. The purpose of this study was to assess the reliability and the accuracy of the pediatric version of the SETS for the triage of pediatric patients. This study was a cross-sectional study among a sample of emergency triage nurses (ETNs) exposed to 17 clinical scenarios using a computerized simulator. The primary outcome was the reliability of the triage level performed by the ETNs. It was assessed using an intraclass correlation coefficient.Secondary outcomes included accuracy of triage compared with expert-based triage levels and factors associated with accurate triage. Eighteen ETNs participated in the study and completed the evaluation of all scenarios, for a total of 306 triage decisions. The intraclass correlation coefficient was 0.80 (95% confidence interval, 0.69-0.91), with an agreement by scenario ranging from 61.1% to 100%. The overall accuracy was 85.8%, and nurses were more likely to undertriage (16.0%) than to overtriage (4.3%). No factor for accurate triage was identified. This simulator-based study showed that the SETS is reliable and accurate among a pediatric population. Future research is needed to confirm these results, compare this triage scale head-to-head with other recognized international tools, and study the SETSped in real-life setting.

Comparison of validity of Korean triage and acuity scale levels assessed by triage nurse in real-time and by retrospectively applying strict systemic inflammatory response syndrome criteria in patients with fever

The strict application of vital signs has substantial risk of over-triage. Therefore, this study assessed the predictive value of Korean Triage and Acuity Scale (KTAS) level calculated using strict Systemic Inflammatory Response Syndrome (SIRS) criteria versus that evaluated by a verified triage nurse (TN). The study is based on a retrospective observational cohort of a single-center emergency department (ED) from 01 May 2018 to 30 April 2019. Study subjects were patients aged ≥18 years with fever. Intensive care unit admission rate or death in ED (IADE) and general ward admission rate according to two differently defined KTAS levels were compared by receiver operating characteristic curve and logistic regression. A total of 2322 patients were included. In comparing the area under the curves (AUCs) of TN- and SIRS-KTAS, TN-KTAS’ predictive power for IADE (0.802) was higher than that of SIRS-KTAS (0.7440, p = 0.0489). The odds ratio of level 3 for IADE (1.35) was not significantly different from that of level 4 in SIRS-KTAS (p = 0.5429). In KTAS, the severity of illness in patients was more accurately predicted by the triage nurse’s decision based on clinical experience than the strict application of SIRS criteria with only vital signs.

Manchester Triage and its outcome in a pediatric cohort: what relationship?

Manchester Triage and its outcome in a pediatric cohort: what relationship?

Determination of medical emergency via new intuitionistic fuzzy correlation measures based on Spearman's correlation coefficient

<abstract><p>Uncertainty in medical diagnosis is the main challenge in medical emergencies (MEs) experienced by triage nurses and physicians in the emergency department (ED). The intuitionistic fuzzy correlation coefficient (IFCC) approach is used to analyze and interpret the relationship between variables in an uncertain environment. Assorted methods that involve applying a correlation coefficient under intuitionistic fuzzy sets (IFSs) were constructed based on Pearson's correlation model with various drawbacks. In this work, we construct two new intuitionistic fuzzy correlation measures (IFCMs) based on Spearman's correlation model. It is demonstrated that the Spearman-based IFCMs are appropriate for measuring correlation coefficients without any drawbacks. In addition, we show that the Spearman-based IFCMs overcome all the shortcomings of the associated IFCC methods. Equally, the Spearman-based IFCMs satisfy the maxims of the correlation coefficient that have been delineated in the classical case of correlation coefficient. Due to the challenges that uncertainty in medical diagnosis pose to MEs and the proficiency of the IFCC approach, we discuss the application of the constructed IFCMs in a triage process for an effective medical diagnosis during an ME. The medical data for the triage process are obtained via a knowledge-based approach. Finally, comparative analyses are carried out to ascertain the validity and authenticity of the developed Spearman-based IFCMs relative to other IFCC approaches.</p></abstract>

Adherence to sepsis protocol in a high-risk maternity reference center.

To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center. This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies. Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases. The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.

Evaluation of Emergency Severity Index (ESI) triage quality by nurses and associated factors in Iran.

The triage process of patients in emergency departments is done by nurses in Iran. it is necessary to pay attention to the ability of nurses in patients' triage in order to have a correct picture of the status of the emergency department, so the aims of this study is to investigate the quality of nurses' triage using the Emergency Severity Index (ESI) method and related factors. This is a descriptive study which was performed on all 900 patients referring to the emergency department during 12 months from 2019 to 2020 in the Triage unit of two trauma center hospitals affiliated to Isfahan university of medical sciences. Data collection tools included patients' demographic, nurses' demographic and occupational checklist, and ESI Triage Form. To analyze the data, SPSS software was used, descriptive and analytic statistics were used, P < 0.05 was considered statistically significant. No significant difference was observed between the quality level of triage by nurses and physicians (P > 0.05), the results of independent t-test showed that nurses in the over triage group have a higher average age and work experience. In the under triage level, the frequency of female nurses was significantly higher than male nurses (P < 0/05). Accurate and fast triage of patients is the key to successful performance in the emergency department. Therefore correct implementation of triage and identifying the need for nurses for training and identifying existing deficiencies are of utmost importance.

Challenges and Barriers Affecting the Quality of Triage in Emergency Departments: A Qualitative Study

Background: Correct and fast triage is the key to successful performance in emergency departments. Various factors can affect the quality of triage; therefore, the present study was conducted to identify and explore the existing challenges in triage units in emergency departments. Materials and Methods: The present study was a qualitative exploratory work conducted via the content analysis approach. Data were collected using in-depth, semi-structured interviews, and focus group interviews. Accordingly, 22 in-depth, semi-structured interviews were conducted in with 18 triage nurses and four emergency medicine specialists on a face-to-face basis. Results: The challenges related to triage nurses fall into two subcategories; lack of clinical competency and psychological capabilities. The challenges related to emergency management consist of challenges in human resources management, structural, and performance. Conclusion: The challenges existing in triage units are influenced by factors related to triage nurses and emergency management. Emergency administrators can improve the effectiveness and quality of triaging patients by empowering triage nurses and removing structural problems in triage units.[GMJ.2019;8:e1619]Â

Maintaining a safe environment in emergency department waiting rooms.

Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses.

Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study.

The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of studies on the patient safety culture among triage nurses. This study aimed to assess the perceptions of the patient safety culture among triage nurses. A cross-sectional survey design was used. The Emergency Medical Services-Safety Attitudes Questionnaire, distributed to triage nurses, was used to collect data. A total of 201 triage nurses participated in this study. The results revealed that the overall average perception of the patient safety culture was 57.27% (SD = 57.27), indicating that the perception of the patient safety culture among triage nurses in the emergency department was non-positive and requires improvement. "Job Satisfaction" received the highest score (63.18%; SD = 17.19), while "Working Conditions" received the lowest (49.91%; SD = 17.37). The perception of positive and negative safety culture responses was statistically significant for age (χ2 (3) = 17.750, p ≤ 0.001), education (χ2 (2) = 6.957, p = 0.031) and length of working experience (χ2 (3) = 8.875, p = 0.031). The findings emphasize the significance of improving the safety culture in relation to several areas of patient care during the triage process. This research serves as a crucial foundation for enhancing patient safety in triage, providing quality care, and reducing adverse events.

Reverse triage: a systematic review of the literature

BackgroundMany techniques to increase hospital surge capacity in the case of a mass casualty incident (MCI) have already been studied, but a new technique, reverse triage, has gained attention. The objective of this systematic review is to provide a comprehensive literature overview regarding the use of the reverse triage principle in emergency and disaster medicine.MethodsA systematic literature review was carried out adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Publications up to May 2023 in the Medline, Embase, CENTRAL, CINAHL, and Web of Science databases were considered. The risk of bias was assessed using the Methodological Items for Non-Randomized Studies, the Risk of Bias Assessment Tool for Systematic Reviews, and Johanna Briggs Institute tools for observational, systematic reviews, and expert opinions respectively.ResultsThe initial search identified 21,259 unique records, of which 16 were included, consisting of 2 reviews, 5 expert opinions, and 9 observational studies. Across studies, an overall surge capacity of 20–30% could be achieved by implementing reverse triage and even more when combined with other strategies. Furthermore, the American framework that comprehended a safe discharge protocol for inpatients is being used in the development of new reverse triage discharge protocols. The risk of developing a complication (adverse event) due to early discharge is rather low.DiscussionDue to the heterogeneity of the included studies, the interpretation of the results should be taken with caution. The most prominent differences were related to study size, university affiliation, health care system, and patient characteristics. Nevertheless, implementing the reverse triage principle in MCIs to guide early discharge of adult inpatients can create additional surge capacity with a minor occurrence of adverse events. A final assessment by a multidisciplinary discharge team (nurses and physicians) remains crucial.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022294136, identifier: CRD42022294136.

Knowledge Level of Nurses about Hospital Triage: A systematic review study

Objective: Triage prioritizes patient care based on the severity of the injury and aims to facilitate the best possible recovery for the majority of individuals within the shortest possible timeframe. This concept holds paramount importance in the realm of emergency care. The objective of this study was to assess the knowledge level of triage nurses working in hospitals. Methods: This systematic review study encompassed an extensive analysis of relevant literature, drawing from international databases such as PubMed, Scopus, Web of Knowledge, and Google Scholar, as well as Iranian databases including SID, Magiran. The search spanned the period from 1980 to 2023. Results: In the present study, 22 articles were selected for data extraction. Across all these articles, it was consistently observed that the knowledge level of the nurses ranged from low to moderate. Furthermore, two interventional studies reported a notable increase in knowledge levels among nurses following training. Conclusion: Based on the findings from multiple studies, it is evident that the knowledge level of triage nurses generally falls within the low to moderate range. Consequently, it is advisable to conduct further studies in a similar vein and implement necessary actions to address this issue.

Triage Accuracy and the Safety of User-Initiated Symptom Assessment With an Electronic Symptom Checker in a Real-Life Setting: Instrument Validation Study.

Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS. This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed. This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse. Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC's assessment was 1 triage level higher than the nurse's triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC's exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety. The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care. RR2-10.2196/41423.

A machine learning system to optimise triage in an adult ophthalmic emergency department: a model development and validation study

A substantial proportion of attendances to ophthalmic emergency departments are for non-urgent presentations. We developed and evaluated a machine learning system (DemDx Ophthalmology Triage System: DOTS) to optimise triage, with the aim of reducing inappropriate emergency attendances and streamlining case referral when necessary. DOTS was built using retrospective tabular data from 11,315 attendances between July 1st, 2021, to June 15th, 2022at Moorfields Eye Hospital Emergency Department (MEH) in London, UK. Demographic and clinical features were used as inputs and a triage recommendation was given ("see immediately", "see within a week", or "see electively"). DOTS was validated temporally and compared with triage nurses' performance (1269 attendances at MEH) and validated externally (761 attendances at the Federal University of Minas Gerais - UFMG, Brazil). It was also tested for biases and robustness to variations in disease incidences. All attendances from patients aged at least 18 years with at least one confirmed diagnosis were included in the study. For identifying ophthalmic emergency attendances, on temporal validation, DOTS had a sensitivity of 94.5% [95% CI 92.3-96.1] and a specificity of 42.4% [38.8-46.1]. For comparison within the same dataset, triage nurses had a sensitivity of 96.4% [94.5-97.7] and a specificity of 25.1% [22.0-28.5]. On external validation at UFMG, DOTS had a sensitivity of 95.2% [92.5-97.0] and a specificity of 32.2% [27.4-37.0]. In simulated scenarios with varying disease incidences, the sensitivity was ≥92.2% and the specificity was ≥36.8%. No differences in sensitivity were found in subgroups of index of multiple deprivation, but the specificity was higher for Q2 when compared to Q4 (Q4 is less deprived than Q2). At MEH, DOTS had similar sensitivity to triage nurses in determining attendance priority; however, with a specificity of 17.3% higher, DOTS resulted in lower rates of patients triaged to be seen immediately at emergency. DOTS showed consistent performance in temporal and external validation, in social-demographic subgroups and was robust to varying relative disease incidences. Further trials are necessary to validate these findings. This system will be prospectively evaluated, considering human-computer interaction, in a clinical trial. The Artificial Intelligence in Health and Care Award (AI_AWARD01671) of the NHS AI Lab under National Institute for Health and Care Research (NIHR) and the Accelerated Access Collaborative (AAC).

Empowering the Radiation Oncology Triage Nurse Role: A Single-Center Analysis.

Triage nurses play a crucial role in addressing patient telephone calls. However, topics that radiation oncology (RO) triage nurses encounter have not been thoroughly investigated. This project established baseline patient issues addressed via telephone by RO triage nurses in a clinically busy academic RO department; identified themes and potential areas for workflow improvement; and evaluated interprofessional perceptions of RO triage from nurses, physicians, and radiation therapists. This two-part study was conducted from September through November 2021 using a retrospective chart review that analyzed patient communications to the RO nurse triage line. Physicians, nurses, and radiation therapists completed an online survey about their experiences with nurse triage. Analysis revealed 13 message themes, with scheduling questions being the most common theme. Survey results indicated that average provider satisfaction with the effectiveness of triage was 3 of 5, perceived triage nurse preparedness to resolve encounters was 3 of 5, and perception of the triage program by physicians was 2.4 of 5.

Triage Accuracy of Emergency Nurses: An Evidence-Based Review

IntroductionAccurate triage assessment by emergency nurses is essential for prioritizing patient care and providing appropriate treatment. Undertriage and overtriage remain an ongoing issue in care of patients who present to the emergency department. The purpose of this literature review was to examine factors associated with triage accuracy in the emergency department. MethodsWe conducted an evidence-based literature review using the Cumulative Index to Nursing and Allied Health Literature, PubMed, and Embase. The search focused on peer-reviewed articles in English, available in full text, published between January 2011 and December 2021. ResultsA total of 14 articles met inclusion criteria and revealed the following 3 themes for triage accuracy: triage nurse characteristics, patient characteristics, and work environment. Triage nurses’ accuracy rates ranged from 59.3% to 82%, with experience in triage associated with higher accuracy. Patient characteristics influenced triage accuracy, with nontrauma patients being undertriaged and trauma patients often overtriaged. The work environment played a role, as accuracy rates varied based on shift time and patient volume. Competing systems between prehospital and ED triage posed challenges and affected accuracy during fluctuations in patient volumes. DiscussionThis review underscores the complex nature of ED triage accuracy. It highlights the importance of nurse experience, training programs, patient characteristics, and the work environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize triage accuracy and improve patient outcomes.

The Effects of Emergency Clinical Practicum at School During the Covid-19 Pandemic

Background: Clinical practicum at emergency department has been suspended during the coronavirus pandemic. Development of innovative clinical education pedagogies is crucial for improving the emergency care knowledge for nursing students, especially those who did not have chance for clinical placement in accident and emergency department. Objective: This quasi-experimental study was to determine whether a hybrid use of flipped classroom and high-fidelity simulations could enhance the knowledge, attitudes, motivation and satisfaction of undergraduate nursing students toward the emergency clinical learning in this critical period. Methods: Three hundred and twenty-two year 4 and 5 undergraduate nursing students were provided with 160 hours of online flipped lectures and high-fidelity simulations. Emergency nursing knowledge of nursing students was tested via multiple choice questions pre- and post-programme. The attitude, motivation and satisfaction with the programme were also measured after the programme was finished. Results: The mean post-test knowledge scores were statistically significantly higher than the pre-test in basic life support nursing, advanced care life support nursing, trauma and disaster nursing, triage nursing and medical and surgical emergency nursing. Additionally, the scores indicated that the students generally had a positive attitude, motivation and satisfaction towards the hybrid teaching methods. Conclusions: The findings of this study support the implementation of the hybrid teaching methods for clinical learning, as it motivates students and develops their confidence over a short clinical learning period. Further development of innovative clinical education pedagogies is crucial to maintain students’ clinical competences when clinical practicum is not allowed beyond the pandemic

Problems experienced by nurses working in the region affected by Kahramanmaraş earthquakes in Turkey and their recommendations for risk reduction: A descriptive and cross-sectional study

Nurses have crucial roles and responsibilities for ensuring the sustainability of health services during disaster periods. One of these roles and responsibilities is to guide future planning efforts in light of their experiences and problems. This study was conducted with 130 nurses as a descriptive and cross-sectional study to identify the experiences and recommendations of nurses working in the region affected by earthquakes centered around the Kahramanmaraş province of Turkey. The snowball sampling method, which is a purposive sampling method, was used in the study, and the data were collected using an online survey form. In this study, it was found that nurses worked as emergency nurses or first aid and triage nurses voluntarily or on temporary assignment in hospitals across the region affected by earthquakes and would like to continue to work in the region. It was discerned that the participants experienced primarily psychological problems at the individual level, and in the context of nursing services, they mostly had managerial and organizational problems during the period when they worked in the region. In light of these problems, the participants recommended that the competencies of nurses be enhanced through training programs and by organizing events to have a more effective disaster preparation, and the managerial skills and psychological coping skills of nurses be improved. In the direction of these results, the experiences and recommendations of nurses should be used for enhancing their disaster preparedness and designing more effective plans for the future, and in particular, their psychological coping skills should be improved, and the management and organization skills of those taking roles in disaster management should be enhanced.

Remote nurse triage and standardization of clinical pathway utilization.

574 Background: In March of 2022, Texas Oncology (community oncology practice) initiated a state-wide rollout for Remote Nurse Triage. This program implemented and standardized the utilization of Clinical Pathways within the Navigating Care system with a goal to decrease time to patient first call back, increase first touch resolution for patient-initiated contact, and increase patient satisfaction related to patient-initiated communication resolution. Methods: To determine an appropriate plan of action, a needs assessment was conducted to evaluate current pathway utilization, call volumes and patient satisfaction. Based on the findings of this assessment, triage nurses were trained to resolve incidents using standardized care pathways and standing orders within the Navigating Care System. This implementation was monitored on a weekly basis with metrics from Navigating Care and the Relatient dashboard and compared to the 12-month baseline data for 2 beta sites. Results: In the 12-month pilot, standardized pathway utilization increased from 1% pre-pilot to 78% post-pilot for clinical symptom management calls. With standardized pathways and better first touch resolution clinical calls decreased 8% overall from 4,302/month to 3,987/month while patient volumes (billable visits) increased 25%. Patient satisfaction scores, in relation to their phone experience and needs resolution, went up to 4.5/5 from 3.9/5. Symptom management resolution times also trended down since beginning the pilot. Conclusions: Standardizing the usage of clinical pathways by virtual triage nurses reduced clinical call volumes despite a positive growth in the number of billable visits at the pilot sites. This increase in pathway utilization also led to decreased time for symptom management resolution. Additionally, these measures resulted in an increased patient satisfaction related to patient-initiated communication.