Triage Education Research Articles

Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care – A cross-sectional study

AimTo determine the reliability of application of the RETTS© triage scale after an educational intervention using paper-based scenarios in emergency care education. BackgroundKnowledge about and education in triage are important factors in triagescale implementation. Presenting students with a large number of triage scenarios is a common part of triage education. MethodsIn this prospective cross-sectional study at two universities students undergoing education in emergency care used RETTS© to assess triage level in 46 paper-based scenarios. Results57 students in the study made 2590 final triage decisions. Fleiss Kappa for final triage was 0.411 which is in the lower range of moderate agreement. In 25 of 46 (53.4%) scenarios, final triage levels did not agree about whether the case was stable or unstable. Conclusion/ImplicationsApplication of the RETTS© triage scale after an educational intervention with paper-based simulation in emergency care education resulted in moderate agreement about the final levels of triage.

Knowledge Of Patient’s Family About The Implementation of Triage In The Emergency Department

Triage is the process by which patients are classified according to the type and urgency of their conditions to get help from a care provider. Patients and the patient families must know about the triage implementation to avoid misinterpretation of health services in the emergency unit. This study aims to identify the knowledge of patients’ families about the implementation of triage in the emergency department. The design of the study was quantitative with a cross-sectional technique. The sample of this study was the patient’s families with 90 people which were selected through accidental sampling. Data collection used was a questionnaire that has been tested for its validation and reliability. Data collected were analyzed using descriptive analysis. The majority of respondents had sufficient knowledge about triage 62,2%, the respondents accounted with better knowledge about triage was 22,2% and the respondents with a lack of knowledge 15,6%. It is be concluded that based on the result of this study, it is beneficial for health care professionals to provide triage education to patient’s families to improve patients' families' understanding of triage implementation in the emergency setting in the hospital

Triaging Admissions: A Survey of Internal Medicine Resident Experiences and Perceptions and Recommendations on Inpatient Triage Education

Transitions of care (TOCs) have been identified as critically important for patient safety. The Joint Commission Center for Transforming Healthcare, World Health Organization, and national societies have emphasized the importance of TOCs.1,2 The literature on TOCs has focused on inpatient to outpatient transitions, and handovers within the hospital.3 Inpatient to outpatient TOCs emphasize communication at discharge and medicine reconciliation to prevent adverse events and readmissions.4 In contrast, the process of admitting patients from outpatient to inpatient settings has only recently begun to receive attention.

The Effect of Competency-Based Triage Education Application on Emergency Nurses' Triage Competency and Performance.

The Korean Triage and Acuity Scale (KTAS) is used to determine emergency patient priority. The purpose of this study was to develop the Competency-Based Triage Education Application (CTEA) using KTAS and evaluate its effectiveness on emergency nurses’ triage competency and performance. The developed CTEA mobile application comprised 4 lectures, 12 text-based cases, and 8 video-based triage scenarios. A quasi-experimental pre-post design with a comparison group (CG) was used to evaluate the effectiveness of the CTEA. Thirty-one participants were assigned to an intervention group (IG) and used the application for at least 100 min over one week. Thirty-five participants were assigned to a CG and underwent book-based learning, which covered the same content as the CTEA. Triage competency (t = 2.55, p = 0.013) and performance (t = 2.11, p = 0.039) were significantly improved in the IG. The IG’s undertriage error was significantly reduced compared to that of the CG (t = 2.08, p = 0.041). These results indicated that the CTEA was effective in improving the emergency nurses’ triage competency and performance. This application will be useful as a program for providing repeated and continuous triage education.

Effect of the Strategic Thinking, Problem Solving Skills, and Grit on the Disaster Triage Ability of Emergency Room Nurses.

In this descriptive study, we aimed to identify factors related to emergency room nurses’ disaster triage ability. A total of 166 nurses who worked for emergency departments of general hospitals completed a structured questionnaire consisting of the Disaster Triage Ability Scale (DTAS), the Strategic Thinking Scale (STS), the Problem-Solving Inventory (PSI), and the Original Grit Scale (Grit-O). The data were analyzed using SPSS/WIN 25.0 by means of descriptive statistics, t-test, one-way ANOVA, the Scheffé post hoc test, Pearson’s correlation coefficients, and stepwise multiple regression. Participants’ DTAS averaged 14.03 ± 4.28 (Range 0–20) and showed a statistically significant difference according to their experience of triage education (t = 2.26, p = 0.022) as a disaster triage-related attribute. There were significant correlations among DTAS and confidence in the PSI (r = 0.30, p < 0.001), the approach-avoidance style in the PSI (r = −0.28, p < 0.001), and futurism in the STS (r = 0.19, p = 0.019). The strongest predictor was confidence in the PSI; in addition, 14.1% of the DTAS was explained by confidence in the PSI, approach-avoidance in the PSI, and futurism in the STS. Emergency room nurses who received triage education showed a higher level of the DTAS and their DTAS could be explained by problem-solving skills and strategic thinking. Therefore, it is necessary to develop and implement triage education programs integrated with stress management to improve the approach-avoidance style to ensure better problem-solving skills and to utilize various training methods to enhance confidence to improve problem-solving skills and futurism as part of strategic thinking.

Simple Triage and Rapid Treatment (START) Health Education Method To Preparedness Nurse of Public Health Center (Puskesmas)

Limited human resources turn triage into an unavoidable solution in disaster management. Simple Triage and Rapid Treatment (START) is a triage method that is widely accepted and easy to use to handle disasters with a time of 30 seconds or less based on three primary examinations such as respiration, checking the radial pulse, mental status. This study aims to identify differences in the preparedness of nurses at the Puskesmas at Kaki Gunung Burni Telong Kabupaten Bener Meriah Regency before and after the health education method intervention (START). The data sources for this study were the nurses of the puskesmas at Kaki Gunung Burni Telong Kabupaten Bener Meriah totaling 20 people. The research design used a quasi-experiment Quasy experiment”. Data was collected using a questionnaire, then for nurses were given the Health Education intervention (START). The results showed that the average knowledge and attitudes of puskesmas nurses before and after health education intervention (START) had increased in dealing with disasters, but there were significant differences in nurses' knowledge in handling disasters with unequal distribution.

An updated national survey of triage and triage related work in Sweden: a cross-sectional descriptive and comparative study

BackgroundTriage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. According to two national surveys from 2005 to 2011, triage was carried out with different triage scales and without guidelines or formal education. Furthermore, a review from 2010 questioned the scientific evidence for both triage as a method as well as the Swedish five level triage scale Medical Emergency Triage and Treatment System (METTS); nevertheless, METTS was applied in 65% of the EDs in 2011. Subsequently, METTS was renamed to Rapid Emergency Triage and Treatment System (RETTS©). The hypothesis for this study is that the method of triage is still applied nationally and that the use of METTS/RETTS© has increased. Hence, the aim is to describe the occurrence and application of triage and triage related work at Swedish Emergency Departments, in comparison with previous national surveys.MethodsIn this cross-sectional study with a descriptive and comparative design, an electronic questionnaire was developed, based on questionnaire from previous studies. The survey was distributed to all hospital affiliated EDs from late March to the middle of July in 2019. The data was analysed with descriptive statistics, by IBM SPSS Statistics, version 26.ResultsOf the 51 (75%) EDs partaking in the study, all (100%) applied triage, and 92% used the Swedish triage scale RETTS©. Even so, there was low concordance in how RETTS© was applied regarding time frames i.e., how long a patient in respective triage level could wait for assessment by a physician. Additionally, the results show a major diversion in how the EDs performed education in triage.ConclusionThis study confirms that triage method is nationally implemented across Swedish EDs. RETTS© is the dominating triage scale but cannot be considered as one triage scale due to the variation with regard to time frames per triage level. Further, a diversion in introduction and education in the pivotal role of triage has been shown. This can be counteracted by national guidelines in what triage scale to use and how to perform triage education.

Get Smart – technological innovations in endodontics part 2: case-difficulty assessment and future perspectives

Given the importance of risk management to avoid mishaps, to achieve a quality result and to ensure a favourable outcome, challenging endodontic cases are best treated by clinicians with the appropriate level of training and experience. Digital and technological innovations in endodontics have led to the development of web-based and smartphone-compatible case-difficulty assessment tools that can help less-experienced dentists identify endodontic management complexities. These interactive tools may also be used for other applications, including primary and secondary care triage, research and dental education. Similarly, advances such as artificial intelligence and mixed reality technologies, are predicted to also benefit endodontics and help support dentists in the management of complex endodontic cases. CPD/Clinical Relevance: Digital and technological developments may help improve the management and treatment of endodontic cases.

What Worked, What Did Not: University Instruction during a Pandemic

What Worked, What Did Not: University Instruction during a Pandemic

Triage Training in Iran from 2010 to 2020: A Systematic Review on Educational Intervention Studies.

Background: Accurate decision-making in triage requires continuous education, so triage nurses should receive annual refresher courses. Identifying the most effective method can make the provision of practical education to triage staff in hospitals possible. This review was conducted with the aim to determine the effectiveness of triage education methods in Iran.Materials and Methods: In this systematic review on educational intervention studies, international and Iranian medical sciences databases were searched using a defined search strategy compatible with each database. PubMed, Scopus, Web of Science, Google Scholar, SID, Islamic Science Center (ISC), and IranDoc databases were searched for literature published from January 2010 to January 2020. The MeSH terms of “health care staff,” “triage,” “education,” and “Iran” in English and Persian were combined to develop a search strategy. Initially, 768 article titles were retrieved. Finally, 16 articles were selected for the review.Results: All conducted studies were quasi-experimental. Half of the studies had used a face-to-face approach for education (workshop, lecture, and simulation), and four studies had used lectures and pamphlets. All studies (except 1) reported that their educational intervention significantly improved nursing knowledge on triage.Conclusions: Almost all studies had reported the effectiveness of an educational intervention in improving nurses' triage knowledge. However, it seems that the non-face-to-face method is superior to the face-to-face method because of its learner-centeredness and cost-effectiveness. Moreover, providing educational content using a blended learning approach (simulation and games) can enhance the effectiveness of triage education.

The impact of simulation-based triage education on nursing students' self-reported clinical reasoning ability: A quasi-experimental study

Few studies have comprehensively examined the effectiveness of simulation-based triage education on clinical reasoning of nursing students. This study evaluated the impact of a simulation-based triage exercise on nursing students’ self-reported clinical reasoning ability. Three cohorts of third-year nursing students were divided into intervention group a (IG a, n = 62), intervention group b (IG b, n = 57), and a control group (CG, n = 53). Students in IG a and IG b participated in a simulation-based triage education consisting of 2 h of multiple patient triage simulations and an hour of structured debriefing. The CG participated in a traditional didactic triage course consisting of a 3-h lecture. Self-reported clinical reasoning ability in pre and post-triage education was measured by the Nurses Clinical Reasoning Scale. There was no significant difference in mean clinical reasoning ability scores between the three groups in pre-test (p > 0.05). Clinical reasoning ability scores in post-test among students in IG a and IG b were significantly higher than those in CG (p < 0.001). Nursing students exposed to a simulation-based triage education had more improvement in self-reported clinical reasoning ability as compared with students who participated in a lecture-based triage education program.

"Flipped Learning" in Disaster Triage: Polarizing Medical Student Attainment?

"Flipped learning" has become increasingly popular in medical education as a means of developing independent learning skills in students. The article by Zheng at al. (2020) highlights the potential utility of this approach in disaster triage training. However, the article also highlights to us some concerns regarding how "flipped learning" may favor certain learners over others in the provision of disaster triage education. Specifically, the article demonstrates the necessity for increased preclassroom preparation when a "flipped classroom" model is used, which inevitably privileges those with a higher ability to engage with self-directed learning. Although such a skill is important to develop in medical education, we fear it may lead to polarized student attainment rather than ensuring a maximum number of students achieve the requisite standard required. More research is consequently needed to inform the most efficacious means of facilitating disaster triage training that supports all students sufficiently, while also helping to nurture their independent learning skills.

Call Me Maybe… A Simulation Based Curriculum for Telephone Triage Education in a Pediatric Residency.

Pediatrician communication with caregivers by phone has traditionally made a significant impact on patient care but remains a source of medical liability. Despite its importance, few publications exist regarding the education of pediatric residents on telephone triage. Our study involved the development of an educational curriculum aimed at expanding the pediatric resident skill set in telephone triage. Our method of curriculum development is based on Kolb's experiential learning theory. We utilized a combination of resource familiarization, didactic education, and simulation in the building of knowledge through reflection upon concrete experience, generalization of knowledge gained, and application of this new knowledge. We developed a 30-min PowerPoint presentation in which instructors reviewed the basic tenets of telephone triage. In the pilot study, residents were divided into two groups—a didactic-first group and a simulation-first group. Their performance was monitored during two scripted, symptom based “parent” phone call simulations. The didactic-first group received the PowerPoint didactic prior to the simulation, and the simulation-first group received the didactic after the simulation. A comparison of resident evaluations by faculty and self-documented confidence level revealed statistically significant higher evaluation scores in the didactic-first group, and an overall improvement in resident confidence with telephone triage. We conclude that this educational curriculum may improve pediatric resident performance in telephone triage.

Understanding nurses perspectives of acuity in the process of emergency mental health triage: a qualitative study

Background: Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim: To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods: An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings: Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion: Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.

Assessment of Attitudes Toward the Emergency Triage System in Belize.

Objective. Triage in resource-limited settings (RLS) improves outcomes. Emergency Triage Assessment and Treatment (ETAT) is a simple triage algorithm that improves assessment and initial management of children in RLS. In Belize, pediatric triage varies with setting, from a 5-level Emergency Severity Index (ESI) used at the National Referral Hospital to a lack of triage at government health centers (GHC). Most data on ETAT implementation are in settings where no triage system existed; data on how to integrate ETAT into existing, heterogeneous triage systems are lacking. The aim of this study is to explore health care providers’ (HCPs) attitudes toward the current triage system prior to national pediatric triage process implementation. Methods. A qualitative study was performed via convenience sampling of HCPs who participated in an ETAT training course using focus groups immediately and 1 year after an initial ETAT training. Focus groups were digitally recorded and transcribed. Three coders analyzed all transcripts to identify emerging themes. Constant comparison analysis was performed until achieving thematic saturation. Results. The following principal themes emerged: (1) importance of triage education and implementation to standardize and improve communication; (2) major limitations of ESI include its complexity, lack of pediatric-specific criteria, and dependence on equipment not consistently available; and (3) desire to implement a simple, low-resource pediatric-specific triage system. Conclusions. Participants believe triage education and process implementation is essential to improve communication and pediatric emergency care. Simple, low-resource pediatric-specific triage systems, like ETAT, may improve utilization by providing faster recognition and improved care for acutely ill children.

Learning at a social distance: A medical student telehealth service for COVID-19 patients.

This article was migrated. The article was marked as recommended. COVID-19 has disrupted traditional forms of clinical practice in both inpatient and outpatient settings. This novel, potentially-fatal infection proliferated to such a degree that many patients with mild disease had to engage in self-care at home. This disruption to clinical services has also upended in-person clerkship education across the country, leading to sustained periods of student furloughing. We developed a telehealth service-learning opportunity for COVID-19 patients who were advised to self-care in their homes. The service was staffed by medical students in their clinical training years, providing triage advice to patients, their families, and co-habitants until their symptoms improved. Callers set patient education around red flag symptoms as their first priority, but also offered counsel on home infection control and self-isolation strategies, composed work letters, offered resources regarding home management issues such as food and sanitation, and attended to the mental health needs of the patients and their families. An attending was on-call daily to assist and educate students about issues relating to clinical decision-making and the social determinants of health. A survey assessed medical students' opinions on the service. Student respondents found the service valuable, with 100% agreeing or strongly agreeing that the service was worth their time and important. Respondents reported learning important telehealth skills such as triage and patient education. Overwhelmingly, students found emotional connections with patients to be the most meaningful aspects of the service. Our telehealth service allowed students to learn from patients in a longitudinal manner, while remaining safely away from clinical settings. This service may prove a useful model for others in the case of another outbreak, particularly when medical students are furloughed. We hope to develop more clinical experiences in telehealth for medical students moving forward.

Metode Pembelajaran dengan Bermain Peran dalam Pendidikan Triase untuk Mahasiswa Keperawatan

The nursing profession requires scientific knowledge, technical abilities and skills. Choosing the right and best teaching method is the most important step in the education process. Role playing is a versatile activity that can facilitate students to learn in real situations. this is a teaching method that has strong and interesting potential to build the skills of nursing students in triage education. Research Objectives: To Provide information about the influence of role-playing method on triage education for nursing students. Method: Sources of research were taken from 3 databases namely PubMed, ProQuest and Ebsco and from Google Scholar using keywords "Role play" or "Role Playing" and "Learning Method" and "Nurse" and "Triage". From the overall results, there are 9 articles that match the inclusion criteria. Results: The 9 articles included in this review. The learning method with role playing influences the nursing students’ communication, cognitive, psychomotor, self reflection, critical thinking and self-efficacy in doing triage process. Conclusion: Role-playing method can facilitate and accommodate increased knowledge and skills. The role-playing method is proven to be able to improve communication, cognitive, psychomotor, self reflection, critical thinking and self-efficacy in nursing triage education.&#x0D; Keywords: Role playing, Learning method, and Triage.

Effect of Triage Education on Nurses’ Performance in Diverse Emergency Departments

&#x0D; &#x0D; &#x0D; Context: Nurses are the primary anchorpersons of triage in emergency departments. Triage nurse should have the proper education and proficiency in emergency triage, decision making, and emergency nursing care. Training on triage is an integral part of emergency nursing education. Poor performance and lack of education are well documented in the literature.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Aim: This study aimed at evaluating the effect of triage education on emergency nurses’ performance in diverse emergency departments.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; methods: Quasi-experimental (pre, post-test design) used to achieve the aim of this study. A purposive sample of one hundred fifty emergency nurses worked at pediatric, Obstetric, and adult emergency departments affiliated to three major governmental hospitals in Beni-Suef Governorate. Assessment of the nurses’ knowledge, practice, and attitude have been done using a self-administered questionnaire, triage competencies observational checklist, and nurses’ attitude measuring scale.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: The study revealed poor nurses’ triage knowledge, practice, and negative attitude for the studied nurses before triage education, compared to a significant improvement after triage educational program, with a statistically significant difference among the three-implementation phases (pre, post, and one month follow up).&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: The nurses who are subjected to triage education improved in their knowledge, practice, and attitude at the post-intervention evaluation compared to their pre-intervention level, which sustained after one month follow up. These findings support the study hypotheses. Based on these findings, the study recommended the publication and dissemination of the triage educational program. Besides, fostering and sustaining the improvements in practices regarding triage in ED through the orientation of new nurses, on the job training, and continuous education.&#x0D; &#x0D; &#x0D;

Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review.

We sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome. Two reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline. Quality was assessed using the Quality Improvement Minimum Quality Criteria Set critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time. Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions, and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (2/11). There are multiple interventions that show potential for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education, and better triage disposition. These changes can help institutions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

Triage Problem Among the Ambulance Crew (Paramedic) in Japan

Introduction:At various accidents or disaster sites, rescue, first aid, and transport to hospitals has been provided by ambulance crews (paramedics). In the case of mass casualties, they also need to operate triage for injured people.Aim:To consider and reveal challenges in triage by ambulance crews (paramedics) on-site.Methods:Interviews of seven ambulance crews (paramedics) and their instructors were conducted and their answers were analyzed.Results:(1.) Triage black tags: declaring “deceased: not able to survive” might give a heavy mental burden and psychological responsibility. Legal protection and an interstitial rule will be necessary in the future. (2.) Missed triage: the ambulance crew cannot perform a triage that may develop a legal problem. It is always important to prevent ambulance crews from being charged. (3.) Triage education and training: there are few triage trainings at fire departments although the number of emergency medical responses is increasing compared to fire response. It will be necessary to increase time of the triage education and training in near future. (4.) Command system (characteristic rank system in the fire department): There is a problem with the rank system in fire departments since confusion occurs when a commander of the First Aid Station is not a licensed paramedic. The ambulance crew (paramedic) usually consists of the three different ranked people. Individual operations are difficult during operation. Education for the paramedic executive is necessary for the fire organization.Discussion:For the triage by ambulance crew (paramedic), legal protection by medical control operation is required, and it may lead to a reduction of heavy mental burden. Triage training is needed to improve the training of triage. The ambulance crew (paramedic) operates under the fire department command system. However, at the time of disaster, the ambulance crew (paramedic) should also work under the medical command system.