Place that patient: An alternative way to educate nurses

Abstract

<p>Session F presented Friday, September 28, 11:30 am-12:30 pm</p> <p><strong>Purpose:</strong> The nature of triage in an emergency department (ED) is inherent with potential risks. Getting the right patient to the right place is the ultimate goal, however it can be complicated. The literature demonstrates that ED&rsquo;s are experiencing increased ED visits, throughput issues, and longer wait times. These additional stressors on a department require the triage nurse to operate at a higher level than they have historically and thus a need was identified for comprehensive triage training. The objective of the project is to facilitate triage education for experienced ED nurses across seven emergency departments applying the principles of sorting, prioritizing, and utilizing the Emergency Severity Index (ESI), an evidence based five level triage algorithm, to help support the principles of sorting and prioritizing.</p> <p><strong>Design:</strong> In this quality assurance project, nurses attend a two hour class that covers the role of a triage nurse, documentation requirements, and the ESI tool. The didactic part of the class is reinforced with an interactive triage game, Place That Patient!, which allows nurses to demonstrate acuity assignment, patient placement, and critical thinking as demonstrated through prioritization and communication. The learning is then followed up by a clinical orientation on the unit with an experienced preceptor with ongoing check-ins and chart reviews. Setting: This health provider operates five community hospitals along with two stand-alone ED&rsquo;s in a metropolitan area.</p> <p><strong>Participants/Subjects:</strong> Inclusion criteria for the class is one year experience working in the ED and the manager&rsquo;s intent to have the nurse fulfill the triage role.</p> <p><strong>Methods:</strong> Participants complete a pre/post survey looking at three separate categories: Performing the role of the triage nurse, describe triage documentation requirements, and assigning an ESI acuity. These categories are rated using a 5 point Likert scale: 1) represents no confidence/understanding, 2) little confidence/understanding, 3) moderate confidence/understanding, 4) good confidence/understanding, and 5) complete confidence/understanding. In addition, five triage case studies are presented prior to the class, with the participants assigning an ESI acuity. The same studies are presented after the class with the learners again assigning an ESI. The pre and post class answers will be compared.</p> <p><strong>Results/Outcomes:</strong> Three classes have been conducted with 50 nurses attending. Over-all, 72.5% report an increase in their confidence/understanding. In the role of the triage nurse, 67.5% have increased confidence, 75% have increased confidence in documentation, and 75% have increased confidence in assigning ESI. The greatest positive increase was seen in assigning ESI with 40% moving from 4) good confidence/understanding to 5) complete confidence/understanding. Additionally there will be one more class taught before the submission on the poster that will have the return demonstration of applying the ESI tool to scenarios. Implications: The results indicated that the nurses perceive increase understanding/confidence in the role as a triage nurse and assigning an ESI acuity. Since our ED&rsquo;s are experiencing record breaking census, this knowledge will lead to nurses having increase confidence and ability to route patients to the appropriate level of care and minimize the risk for those patients still waiting which is paramount for safe patient care.</p>