Nurses' and patients' views regarding triage in the accident and Emergency Department.

Abstract

The aim of this study was to explore views of patients and nurses regarding the triage process in the A/E department at St. Luke's Hospital. The sample consisted of 46 nurses and 35 clients working and attending this department. Response rates of 63% (nurses) and 85% (patients) were achieved. Data collection was done through quantitative designs using self administered questionnaires and also through qualitative techniques using a focus group discussion with 3 experienced nurses. Findings revealed that triage is perceived in different ways amongst clients and nurses in this department. A significant number of attendees in this department are aware how the system functions but nurses thought otherwise. Most clients associate quality service with waiting times and the more they wait the less they picture the service as efficient. Priority two clients experience the longest waiting time with a mean of 3 hours 5 minutes. Most clients also thought that the A/E department is the only option for their care and that health professionals in this department were very efficient. Feedback to clients on their condition and length of waiting together with improvements in primary health centres were considered as important determinants to improve the process of triage in the A & E department. Nurses are aware that triage can categorise patients well into clinical priorities and control patient flow in an A/E department. However in our local department these fundamental issues of efficient prioritisation and flow of patients were lacking indicating the system is not functioning appropriately. Different opinions were given as to who is the most appropriate person to conduct triage in the quantitative design whilst qualitative methods revealed triage is a nursing role. However both designs urged the need for more education, training, guidelines and protocols about this process. Also most nursing participants maintained that the current process required some changes to be more efficient and effective outlining a major change was needed. Using a 5 category system was mentioned by most of the participants instead of the current 3 tier system. Some of the proposed recommendations put forward also highlighted suggestions regarding management solutions along with educational and practical alternatives.