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Electronic Alerts for Triage Protocol Compliance Among Emergency Department Triage Nurses: A Randomized Controlled Trial

Holmes, James F.; Freilich, Joshua; Taylor, Sandra L.; Buettner, David

doi: 10.1097/NNR.0000000000000094
POINT-OF-CARE RESEARCH SERIES
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Background Alerts embedded in electronic health records (EHRs) are designed to improve processes at the point of care.

Objective The aim of this study was to determine if an EHR alert—at emergency department (ED) triage—increases the ED triage nurse’s utilization of triage protocols.

Methods ED triage nurses were randomized to receive either a passive EHR alert or no intervention for patients with the following complaints: minor trauma with extremity injuries or female patients with abdominal pain. The EHR alert notified the nurse that the patient was eligible for diagnostic testing: radiographs for patients with injured extremities or urinalysis for female patients with abdominal pain.

Results Twenty-eight nurses triaged 20,410 patients in the 6 months before the intervention and 19,157 in the 6 months after the intervention. Before the intervention, the urinalysis protocol was implemented in 101/624 (16.2%) patients triaged by the intervention group and 116/711 (16.3%) triaged by the control group. After the intervention, the urinalysis protocol was implemented in 146/530 (27.6%) patients triaged by the intervention group and 174/679 (25.6%) triaged by the control group. Before the intervention, the radiograph protocol was implemented in 58/774 (7.5%) patients triaged by the intervention group and 45/684 (6.6%) triaged by the control group. After the intervention, the radiograph protocol was implemented in 78/614 (12.7%) patients triaged by the intervention group and 79/609 (13.0%) triaged by the control group.

Conclusion The use of a passive EHR alert to promote ED triage protocols showed little benefit. Before the widespread implementation of EHR alerts for patient care, rigorous studies are required to determine the best alert methods and the impacts of such interventions.

James F. Holmes, MD, MPH, is Professor; and Joshua Freilich, RN, MSN, MHA, is Assistant Nurse Manager, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California.

Sandra L. Taylor, PhD, is Senior Statistician, Clinical Translational Science Center, UC Davis School of Medicine, Sacramento, California.

David Buettner, RN, MS, is Emergency Department Clinical Resource Nurse and Clinical Information System Analyst, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California.

Accepted for publication February 5, 2015.

The project described was supported by the Emergency Medicine Foundation (EMF/ENAF Directed Team Grant) and The National Center for Advancing Translational Sciences, National Institutes of Health (through Grant UL1 TR000002). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no conflicts of interest to report.

Corresponding author: James F. Holmes, MD, MPH, Department of Emergency Medicine, UC Davis Medical Center, 2315 Stockton Boulevard, PSSB, Sacramento, CA 95817-2282 (e-mail: jfholmes@ucdavis.edu).

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