Utilizing standardized patient simulations to determine ESI accuracy
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Denise Campbell, DNP, MSN, RN, ACNS-BC, CEN, CHSE; Scott Slater, BSN, RN; Alayna Perko, BSN, RN, CEN; Jac Getzinger, Sr., MSN, RN
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Poster presentation
Session B presented Monday, September 30,11:30 am-12:30 pm
Purpose: Triage is used in emergency departments (ED) to sort patients for treatment. Triage considers the level of acuity of patients for life threatening conditions as well as the number of resources patients will require for care. Because of the challenges ED's face, using a reliable and valid tool – the emergency severity index (ESI) - helps to ensure the critically ill patients receive treatment in a timely manner. Lack of formal training, high acuity, staffing and interruptions can interfere with triage nurses not assigning ESI accurately. The purpose of this evidence based practice project is to measure the effect of using standardized patient simulated video scenarios to improve the accuracy of ESI scores assigned by emergency triage nurses.
Design: This project was a descriptive study utilizing chart reviews and standardized patient (SP) video simulated scenarios as the intervention to assess the accuracy of assigning ESI to patients by the triage care coordinators.
Setting: The project was completed in a Level I trauma center ED in the Midwest.
Participants/Subjects: Participants were ED nurses who have been trained and function in the role of triage care coordinator (TCC) and who have access to a cell phone. Confidentiality has been maintained by assigning a unique identifier to each of the TCCs included in the project.
Methods: The first phase of this project consisted of investigators retrospectively reviewing charts of the TCCs participating in the project and evaluating whether a correct ESI score was assigned. The software package PASS 15: version 15.0.2 was utilized by a trained statistician to determine that 15 charts per TCC would provide enough data to determine 95% power in our statistical analysis of the accuracy of ESI. The ESI algorithm from the Agency for Healthcare Research and Quality (AHRQ) was referenced to determine correct responses. Phase two included videotaping twelve SP simulated scenarios utilizing the AHRQ ESI resources. One video per week was texted to the TCCs participating in the study. The TCCs reviewed the video and replied via text messaging what they thought the correct ESI score was. The following week the correct ESI with rationale was texted messaged to the TCCs providing them with feedback as to why the patient was assigned the appropriate ESI. This process repeated for twelve weeks. Phase three consisted of chart reviews of the TCCs post intervention to assess for improvement in ESI assigning.
Results/Outcomes: Upon completion of retrospective chart reviews prior to the intervention, 73% of the ESI scores were correct. Weekly video simulated text messaging had 75% correct responses. As each week progressed correct responses improved. Data collection post intervention is currently being obtained.
Implications: Since there can be inconsistency in triage nurses assigning ESI scores it is important to continuously provide education and assess competency of the triage nurse to assure that patients are receiving prompt and appropriate care as necessary for their acuity level. Based on the high level of liability the triage area presents, special consideration needs to be made when deciding which nurse should be assigned to that area.
Type | Poster |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Triage; ESI; Emergency |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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