The use and feasibility of an online software system to support assessment of accuracy and consistency in applying the Australasian Triage Scale.

BACKGROUND: The purpose of this study was to evaluate the use and feasibility of a software system called the Triage Quality Assessment Software in New South Wales emergency departments, to assist in evaluating triage decision accuracy and consistency of emergency nurses in applying the Australasian Triage Scale. METHOD: A descriptive, exploratory study comprising of retrospective audit data and survey, was conducted 12-months post-implementation of the Triage Quality Assessment Software system. RESULTS: Between January to December 2018, a total of 39 audits were completed comprising 4214 triage records, of which 3952 (93.3%) contained sufficient information to be evaluated. Triage decision accuracy was 58.3% with a moderate level (KW=0.57) of consistency demonstrated. Overall feasibility was high (4.2). Findings confirmed learnability (4.3), usability (4.2) and acceptability (4.2) of Triage Quality Assessment Software. CONCLUSION: This is the first software system to be developed to assist in evaluating triage decision accuracy and consistency in applying the Australasian Triage Scale. This study provides evidence that triage decision accuracy and consistency are detectable and quantifiable. The feasibility of Triage Quality Assessment Software is supported, with further testing needed to fully evaluate its role in emergency department triage quality improvement.

Triage in Australian emergency departments: Results of a New South Wales survey.

AIM: To describe current models of triage, the preparation and education of triage nurses, and methods of auditing triage practice in New South Wales emergency departments. BACKGROUND: Triage is a critical component of emergency department practice; affecting patient safety and access to emergency care. Within Australia, triage is an autonomous role predominantly conducted by trained emergency nurses. Patient safety and timely access to emergency care relies upon the experience, education and training of emergency triage nurses. To date, little is known about triage models of care, the preparation and education of triage nurses, and assessment of triage practice and decision accuracy. METHOD: Descriptive, exploratory study design employing a self-reporting cross-sectional survey of clinical nurse consultants and educators in New South Wales. RESULTS: The survey results reveal variability in models of triage, and the eligibility, preparation and education requirements of triage nurses; that appear geographically related. Auditing of triage practice was commonly undertaken retrospectively; feedback to triage nurses was infrequent. The survey found evidence of locally developed guidelines directing triage category allocation for specific conditions or symptoms. CONCLUSION: The purpose of triage is to ensure that the level of emergency care provided is commensurate with clinical urgency. Variability in the preparation, education and evaluation of triage nurses may in and of itself, contribute to poor patient outcomes. Further, workforce size and geography may impede auditing and the provision of feedback, which are critical to improving triage practice and triage nurse performance. It is imperative that the Emergency Triage Education Kit be revised and maintained in tandem with future revisions of the Australasian Triage Scale.

Development and preliminary testing of an online software system to facilitate assessment of accuracy and consistency in applying the Australasian Triage Scale.

PURPOSE: The aim of this project was to design and evaluate an online software system to facilitate the assessment of triage decision accuracy and consistency in applying the Australasian Triage Scale. BACKGROUND: Triage is a critical component of emergency nursing practice, which affects patient access to emergency care. Accurate and consistent triage decisions are vital to ensuring patient safety, timely access to care and ED operation. Presently, there is no standard process to examine triage decisions, measure current performance and support department and individual performance development activities to improve patient safety and quality of emergency care. METHOD: An iterative design guided by a human factors development approach was used to develop a retrospective, focus-based analysis system to evaluate triage decision accuracy and consistency, and enable the exploration of service gaps and opportunities for practice change and professional development. RESULTS: Triage decision accuracy and consistency, including areas for improvement are detectable and quantifiable. Findings generated may aid in departmental performance and professional development of triage nurses. CONCLUSION: This is the first system developed to assess decision accuracy and consistency in applying the Australasian Triage Scale. This paper has described the development and preliminary testing of a user-centred design process and implementation of a web-based system to evaluate triage decision accuracy and consistency.

A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice.

Triage is a critical component in the delivery of time-sensitive emergency care. Decision-making and the activity of the triage nurse affect patient access to care and allocation of emergency department (ED) resources. It is important to be able to evaluate decision-making at triage to ensure patient safety, and to identify opportunities for professional and service development. At present, there is no standard approach to retrospective examination of triage decisions using the Australasian Triage Scale. The aim of this literature review is to identify the quality control strategies used in triage and the factors that appear to influence triage decisions in relation to the Australasian Triage Scale.

Family presence during resuscitation and invasive procedures.

The practice of allowing family to be present during patient resuscitation or invasive procedures (Family Presence) is gaining acceptance in North America and the United Kingdom in controlled circumstances. Research into Family Presence has demonstrated multiple benefits for the patient, family and health care team. These advantages include helping the family to understand the severity of the illness/trauma and to see that appropriate attempts were undertaken to save their loved one. Family Presence can also facilitate improved communication between the health care team and family. In spite of evidence supporting Family Presence as a useful practice for patient, family and health care team, the use of Family Presence is uncommon within Australian emergency departments and hospitals. Clear expectations at organisational, governmental and professional levels are essential to effectively implement this approach. To be supported in the clinical area, the success of a Family Presence program requires an inclusive approach to program development. A critical component of a successful Family Presence program is a family facilitator who is adequately prepared for the role and committed to supporting the family during resuscitation or invasive procedures. Research exploring Family Presence in Australia is lacking and highlights the need for context specific research in this area.

Violence and aggression in the emergency department: a critical care perspective.

Aggression and violence are common in the emergency setting, with nurses out-ranking police and prison officers in exposure to workplace violence. This paper examines the current literature to identify the incidence of violence within the ED, precipitators of violence and aggression and the government policy directive of 'zero tolerance'. Methods of managing violence and aggression are explored, including environmental management, de-escalation, pharmacological and physical restraint and seclusion and these are linked to course content recommended for staff training.