Triaging the Emergency Department, Not the Patient: United States Emergency Nurses' Experience of the Triage Process

Introduction: Triage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter. Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an "immediate bedding" or "pull until full" approach, in which patients are placed in treatment areas as they become available without previous screening. The purpose of this study was to explore emergency nurses' understanding of-and experience with-the triage process, and to identify facilitators and barriers to accurate acuity assignation.

Methods: An exploratory qualitative study using focus-group interviews (N = 26).

Results: Five themes were identified: (1) "Sick or not sick," (2) "Competency/qualifications," (3) "Triaging the emergency department, not the patient," (4) "The unexpected," and (5) "Barriers and facilitators."

Discussion: Our participants described processes that were unit- and/or nurse-dependent and were manipulations of the triage system to "fix" problems in ED flow, rather than a standard application of a triage system. Our participants reported that, in practice, the use of triage scales to determine acuity and route patients to appropriate resources varies in accuracy and application among emergency nurses and in their respective emergency departments. Nurses in this sample reported a prevalence of "quick look" triage approaches that do not rely on physiologic data to make acuity decisions. Future research should focus on intervention and comparison studies examining the effect of staffing, nurse experience, hospital policies, and length of shift on the accuracy of triage decision making. Contribution to Emergency Nursing Practice.