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Improving Triage Accuracy

A Staff Development Approach

Brosinski, Carmen M. CDR, MSN, RN, SANE-A; Riddell, Autumn J. LCDR, MSN, RN, CEN; Valdez, Sherwin LCDR(Ret), MSN, RN, CEN

doi: 10.1097/NUR.0000000000000291
Feature Article

Purpose: The purpose of the process improvement initiative was to improve the percentage of undertriaged patients to less than 10% (benchmark) using the Emergency Severity Index tool. Undertriaged patients have an increased potential for poor outcomes due to a lengthier waiting room stay, which results in delay of care.

Description of the Project: An evidence-based project designed for staff development was conducted for a 7-month period. Project procedures consisted of triage chart reviews for a 3-month period during pre– and post–Emergency Severity Index training. Emergency Severity Index refresher training for nurses triaging in the emergency department was conducted for a 1-month period.

Outcome: Chart reviews revealed that 102 of 388 patients (26.3%) were undertriaged before Emergency Severity Index training. After Emergency Severity Index training, chart reviews depicted that 41 of 440 patients (9.3%) were undertriaged. This difference was statically significant (P < .001), when tested using a 1-sided t test at the 95% confidence level and achieving at least 80% power.

Implications: Regardless of previous training or years of emergency department nursing experience, triage refresher training has been shown to increase accuracy of triage categorization, thus leading to a decreased risk of poor patient outcomes.

Author Affiliations: Assistant Department Head (Ms Brosinski) and Clinical Nurse Specialist (Ms Riddell), Naval Medical Center Portsmouth, Virginia; and Clinical Nurse Specialist (Mr Valdez), Naval Medical Center San Diego, California.

The authors report no conflicts of interest.

Correspondence: Carmen M. Brosinski, CDR, MSN, RN, SANE-A, Naval Medical Center Portsmouth, 4917 Hatton Point Rd, Portsmouth, VA 23703 (

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