Hitchcock Maree, Gillespie Brigid, Crilly Julia, Chaboyer Wendy
Research Centre for Clinical and Community Practice Innovation, Griffith University, Gold Coast, Queensland, Australia.
J Adv Nurs. 2014 Jul;70(7):1532-41. doi: 10.1111/jan.12304. Epub 2013 Dec 23.
To explore and describe the triage process in the Emergency Department to identify problems and potential vulnerabilities that may affect the triage process.
Triage is the first step in the patient journey in the Emergency Department and is often the front line in reducing the potential for errors and mistakes.
A fieldwork study to provide an in-depth appreciation and understanding of the triage process.
Fieldwork included unstructured observer-only observation, field notes, informal and formal interviews that were conducted over the months of June, July and August 2012. Over 170 hours of observation were performed covering day, evening and night shifts, 7 days of the week. Sixty episodes of triage were observed; 31 informal interviews and 14 formal interviews were completed. Thematic analysis was used.
Three themes were identified from the analysis of the data and included: 'negotiating patient flow and care delivery through the Emergency Department'; 'interdisciplinary team communicating and collaborating to provide appropriate and safe care to patients'; and 'varying levels of competence of the triage nurse'. In these themes, vulnerabilities and problems described included over and under triage, extended time to triage assessment, triage errors, multiple patients arriving simultaneously, emergency department and hospital overcrowding.
Findings suggest that vulnerabilities in the triage process may cause disruptions to patient flow and compromise care, thus potentially impacting nurses' ability to provide safe and effective care.
探讨并描述急诊科的分诊流程，以识别可能影响分诊流程的问题和潜在漏洞。
分诊是患者在急诊科就医旅程的第一步，通常是减少潜在错误的前沿防线。
一项实地研究，以深入了解和认识分诊流程。
实地工作包括在2012年6月、7月和8月进行的无结构化纯观察、现场记录、非正式和正式访谈。进行了超过170小时的观察，涵盖一周七天的日班、晚班和夜班。观察了60次分诊过程；完成了31次非正式访谈和14次正式访谈。采用了主题分析法。
通过对数据的分析确定了三个主题，包括：“在急诊科协调患者流量和护理服务”；“跨学科团队沟通与协作，为患者提供适当和安全的护理”；以及“分诊护士的不同能力水平”。在这些主题中，所描述的漏洞和问题包括分诊过度和不足、分诊评估时间延长、分诊错误、多名患者同时到达、急诊科和医院过度拥挤。
研究结果表明，分诊流程中的漏洞可能会导致患者流量中断并损害护理质量，从而可能影响护士提供安全有效护理的能力。
