Promoting Staff Satisfaction and Improving Patient Safety Through Implementation of a Five Level Triage System in the ED

Purpose:
ED overcrowding is a health care crisis nationwide. Treatment delays threaten patient safety. As EDs continue with overcrowded conditions, it is necessary to develop accurate, valid, and reliable triage systems. Current studies question the reliability and validity of the three-level acuity scale.

Significance:
Ed overcrowding is identified as a health care crisis linked to delays in treatment and a threat to patient safety and a threat to public health. Triage nurses experience stress as a result of swiftly and accurately prioritizing which patients must be seen immediately and who can safely wait.

Strategy and Implementation:
Triage nurses in the ED will be asked to participate in a pre-test, post-test focusing on the level of stress and professional satisfaction that is experienced both prior to and three months following the implementation of the five level triage acuity system. All triage nurses will participate in the four hour ESI educational session involving an introduction of the ESI program, a review of the algorithm, practice cases, and competency testing. The program will include lecture, video, discussion utilizing case studies, and testing. Patients will be accurately triaged to improve patient safety and identify appropriate utilization of resources. In previous studies, triage nurses have identified the ESI triage system as easier to use, and a more useful tool, than the previous three level triage system.( Gilboy, Tanabe,)

Evaluation:
There is an improvement in the perception of safe care delivery to patients in the ED. There is an improvement in the feeling of confidence in triage acuity assignment by the nurses in the ED as evidenced by survey results of 15.78% pre-test up to 68.42% post-test.

Implications for Practice:
By accurately triaging patients and utilizing appropriate allocation of resources, the five level triage system is instrumental in improving both nursing satisfaction and patient safety.