Using Simulation to Assess the Impact of Triage Interruptions

IntroductionInterruptions are common in the emergency department and contribute to catastrophic errors. Care priorities and acuity levels are assigned during triage, meaning that mistakes and omissions during the triage process could have detrimental effects on patients. The purpose of this project was to assess the feasibility of investigating the impact of interruptions on triage and the decision-making process in a simulated setting.MethodsA 2-phase, sequential exploratory mixed method design was used. Nine nurses from 3 emergency departments in a Midwest area participated. A short demographic questionnaire was used to collect information about the nurses' education and experience. The Emergency Severity Index (ESI) was used for triage categorization. Each participant completed 2 scenarios (one interrupted and one uninterrupted). After completion of the scenarios, video-simulated recall interviews were used to assess the simulation experience and the impact that interruptions had on the triage decision-making process.ResultsTriage time had a mean of 10 minutes and ranged between 4.34 minutes and 13.45 minutes. However, triage was significantly longer during the interrupted scenarios. Seventy-seven percent of the acuity assessments (ESI) were correct. Of the 18 scenarios, 3 uninterrupted scenarios had incorrect ESI scores, and one interrupted scenario had a missing acuity score.DiscussionThis study provides the basis for future work that looks at how nurses successfully manage interruptions and tests interventions to assist triage nurses in managing or reducing interruptions during this important patient assessment process.Contribution to Emergency Nursing Practice
- This research is innovative because simulation has not previously been used to assess the impact of interruptions on triage.
- Emergency nurse educators could use the methods and results discussed in this project to guide departmental training of triage nurses.
- Practicing in a simulated setting can help new triage nurses hone their skills at managing interruptions while providing veteran triage nurses with ways to recognize factors that are affecting the accuracy of their triage.