The accuracy with which the Australasian Triage Scale is applied is vital to positive patient outcomes. The reliability of the ATS when it is applied to special groups, such as children, mental health patients and pregnant women, is questionable. It is believed consistent education may lead to optimal triage nurse decision-making. The Emergency Triage Education Kit (ETEK) was developed to address the education needs of triage nurses. It is hoped that the use of ETEK will result in more consistent application of the ATS and improved accuracy of triage scores.
The aim of the study was to evaluate the impact of the Emergency Triage Education Kit on paediatric nursing triage.
The study was undertaken in two phases between 2009 and 2011 in the Emergency Department of the Royal Children’s Hospital, Brisbane. In the first phase, the effectiveness of ETEK was assessed using a pre-test post-test questionnaire. We compared the answers to paper-based paediatric triage scenarios with expected responses from ETEK. The questionnaires were completed immediately pre- and post-intervention and at 12-month follow-up. The second phase utilised a single retrospective, randomised chart audit to examine the ability of a component of ETEK, the paediatric physiological discriminator table, as a tool to audit paediatric emergency nurses’ triage practice.
The results of Phase One found there was no significant difference in the total number of correct answers between pre- and post-intervention (p=0.25) or between pre-intervention and 12-month follow-up (p=0.43). Nurses aged 34 years or younger allocated triage categories correctly more often than older nurses (p=0.007). Feedback from the nurses regarding the ETEK-based triage scenarios was variable. Some nurses commented that they found it difficult to translate the limited information of the scenarios into a triage category. In particular, nurses found that the description of key characteristics of the primary assessment (airway, breathing, circulation and disability) were omitted and therefore difficult to categorise. Phase Two found that the number of occasions on which parallel decision-making could not be utilised by the researchers decreased significantly according to the year of presentation (2007; 112 (56%), 2008; 106 (53%), 2010; 13 (7%), P<0.001). When decision-making could be replicated by the researcher, there was improvement in matched triage scores (2007; 55%, 2008; 69%, 2010; 72%, P=0.01). The most improved reporting occurred in the ‘airway’ and ‘breathing’ assessments.
By using ETEK as the preferred resource, consistent education promoted improved decision-making and more accurate triage category allocation. In this emergency department, ETEK has been shown to meet its’ original aim; consistency in education promotes consistent application of the ATS and improves triage accuracy.