Cover Image

Challenges and Barriers Affecting the Quality of Triage in Emergency Departments: A Qualitative Study

Mostafa Bijani, Ali Asghar Khaleghi

Background: Correct and fast triage is the key to successful performance in emergency departments. Various factors can affect the quality of triage; therefore, the present study was conducted to identify and explore the existing challenges in triage units in emergency departments. Materials and Methods: The present study was a qualitative exploratory work conducted via the content analysis approach. Data were collected using in-depth, semi-structured interviews, and focus group interviews. Accordingly, 22 in-depth, semi-structured interviews were conducted in with 18 triage nurses and four emergency medicine specialists on a face-to-face basis. Results: The challenges related to triage nurses fall into two subcategories; lack of clinical competency and psychological capabilities. The challenges related to emergency management consist of challenges in human resources management, structural, and performance. Conclusion: The challenges existing in triage units are influenced by factors related to triage nurses and emergency management. Emergency administrators can improve the effectiveness and quality of triaging patients by empowering triage nurses and removing structural problems in triage units.[GMJ.2019;8:e1619] 

Triage; Nurses; Qualitative Research; Emergency Department

- Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci. 2017; 22(1):23-27.

https://doi.org/10.4103/1735-1995.200277

PMid:28413420 PMCid:PMC5377968

- Love RA, Murphy JA, Lietz TE, Jordan KS. The effectiveness of a provider in triage in the emergency department: a quality improvement initiative to improve patient flow. Adv Emerg Nurs J. 2012;34(1):65.

https://doi.org/10.1097/TME.0b013e3182435543

PMid:22313903

- Jordi K, Grossmann F, Gaddis GM, Cignacco E, Denhaerynck K, Schwendimann R, et al. Nurses' accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals. Scand J Trauma Resusc Emerg Med. 2015;23:62.

https://doi.org/10.1186/s13049-015-0142-y

PMid:26310569 PMCid:PMC4551516

- Robinson DJ. An integrative review: Triage protocols and the effect on ED length of stay. J Emerg Nurs . 2013;39(4):398-408.

https://doi.org/10.1016/j.jen.2011.12.016

PMid:22513188

- Buschhorn HM, Strout TD, Sholl JM, Baumann MR. Emergency medical services triage using the emergency severity index: is it reliable and valid? J Emerg Nurs. 2013 Sep;39(5):e55-63

https://doi.org/10.1016/j.jen.2011.11.003

PMid:22244546

- Ganley L, Gloster AS. An overview of triage in the emergency department. Nursing Standard. 2011; 26(12):49-56.

https://doi.org/10.7748/ns.26.12.49.s55

- O'Connor E, Gatien M, Weir C, Calder L. Evaluat-ing the effect of emergency department crowdingon triage destination. Int J Emerg Med 2014;7:16.

https://doi.org/10.1186/1865-1380-7-16

PMid:24860626 PMCid:PMC4016736

- Fathoni M, Sangchan H, Songwathana P. Triage knowledge and skills among emergency nurses in East Java Province, Indonesia. Aust Emerg Nurs J. 2010;13(4):153.

https://doi.org/10.1016/j.aenj.2010.08.304

- Rahmati H, Azmoon M, Meibodi MK , Zare N. Effects of Triage Education on Knowledge, Practice and Qualitative Index of Emergency Room Staff: A Quasi- Interventional Study. Bull Emerg Trauma. 2013;1(2):69-75.

- Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open. 2016 ; 2: 8-14.

https://doi.org/10.1016/j.npls.2016.01.001

- Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing and Health Sciences. 2013;15(3):398-405.

https://doi.org/10.1111/nhs.12048

PMid:23480423

- Graneheim UH , Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004; 24(2):105-12.

https://doi.org/10.1016/j.nedt.2003.10.001

PMid:14769454

- Loh J. Inquiry into Issues of Trustworthiness and Quality in Narrative Studies: A Perspective. The Qualitative Report. 2013; 18(33): 1-15.

- Cypress BS. Rigor or Reliability and Validity in Qualitative Research: Perspectives, Strategies, Reconceptualization, and Recommendations. Dimens Crit Care Nurs 2017;36(4):253-63.

https://doi.org/10.1097/DCC.0000000000000253

PMid:28570380

- Ghanbari A, Hasandoost F, Lyili EK , Khomeiran RT , Momeni M. Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study. Iran J Nurs Midwifery Res. 2017;22(4):280-286.

https://doi.org/10.4103/1735-9066.212990

PMid:28904540 PMCid:PMC5590357

- Duko B, Geja E, Oltaye Z, Belayneh F, Kedir A, Gebire M. Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study. BMC Res Notes. 2019. 14;12(1):21.

https://doi.org/10.1186/s13104-019-4062-1

PMid:30642384 PMCid:PMC6332676

- Reisi Z, Saberipour B, Adienh M, Hemmatipour A, Abdolahi Shahvali E. The level of awareness of the emergency department nurses of the triage principles in teaching hospitals. J Nurs Midwifery Sci . 2018;5:32-7.

- Aloyce R, Leshabari S, Brysiewicz P. Assessment of knowledge and skills of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania. African Journal of Emergency Medicine. 2014:4(1):14-18.

https://doi.org/10.1016/j.afjem.2013.04.009

- Rahmani F, Sepehri Majd P, Ebrahimi Bakhtavar H, Rahmani F. Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis. J Emerg Prac Trauma. 2018;4(1):9-13.

https://doi.org/10.15171/jept.2017.19

- . Lin CC, Liang HF, Han CY, Chen LC, Hsieh CL. Professional resilience among nurses working in an overcrowded emergency department in Taiwan. Int Emerg Nurs. 2019 Jan;42:44-50.

https://doi.org/10.1016/j.ienj.2018.05.005

PMid:29954706

- Mohseni M, Seyedin H, Hosseini AF. Relationship between Psychological Empowerment of Managers and Performance Accountability in Hospitals Affiliated to Tehran University of Medical Sciences, Tehran, Iran.Journal of Patient Safety and Quality Improvement. 2019; 7(1): 13-18.

- Rosenberg K. RN Shortages Negatively Impact Patient Safety. Am J Nurs. 2019; 119(3):51.

https://doi.org/10.1097/01.NAJ.0000554040.98991.23

PMid:30801322

- Li H, Cheng B, Zhu XP. Quantification of burnout in emergency nurses: A systematic review and meta-analysis. Int Emerg Nurs. 2018 ;39:46-54.

https://doi.org/10.1016/j.ienj.2017.12.005

PMid:29361420

Refbacks

  • There are currently no refbacks.