Are Emergency Departments in the United States Following Recommendations by the Emergency Severity Index to Promote Quality Triage and Reliability?

INTRODUCTION

The purpose of this study was to explore and describe (1) the extent to which emergency departments in the United States are promoting the quality of triage and the reliability of triage systems according to recommendations in the Emergency Severity Index (ESI) Handbook and (2) if relationships existed between triage structure (policies) and process (procedures) in emergency departments that promote accuracy of triage decisions.

METHODS

Donabedian's Structure, Process, Outcome model guided this descriptive, correlational study. Nurses were recruited from all geographic regions in the United States, and the ED TRiAGE Structure and Process Survey was developed to collect data. Χ tests of independence, Fisher's exact tests, and Kendall's τ were used to assess relationships of structure and process.

RESULTS

The majority of emergency departments did not meet at least the minimum recommendations of the ESI triage system. Significant positive relationships were found when an emergency department had structure (policy) to guide process (procedures). Differences were reported in the type, amount, and focus of the policies and procedures.

DISCUSSION

Donabedian's model emphasizes that good structure and process are antecedents of good outcomes. This study serves as a foundation on which to examine the consistency of emergency departments meeting the ESI guidelines that promote triage accuracy and maintaining the reliability of evidence-based triage acuity systems.