What is the effect on knowledge, staff satisfaction and competency of care after educating providers on emergency department triage in an urban academic medical center?

Abstract

<p>Session presented on Saturday, July 25, 2015:</p> <p><strong>Background.</strong> Hospitals in recent years have shown an increase in overcrowding in their emergency departments due to hospital closures, lack of primary care and an aging population. Many patients are not receiving appropriate timely care, which may result in delays in treatment, adverse events, and even death. Triage is defined as the process of sorting and prioritizing patients for care (Moller et al., 2010, p.746) Critical thinking is necessary for the triage or 'sorting' and the identification of the ill patient is an important process to avoid adverse events.</p> <p><strong>Purpose.</strong> The purpose of this study is to demonstrate an innovative education delivery model of the triage process to increase knowledge of registered nurses in the emergency department. This curriculum development will improve knowledge base of nursing staff; improve staff satisfaction and competency of care. Theoretical Framework. The adult learning theory model by Malcolm Knowles is used in this educational program. In this learning theory, Knowles examined adults leaRNs and described the difference from children. Knowles believed education should be adapted to their learning process. Knowles identified 5 charactertics: self-concept, experience, readiness to leaRNorientation to learning and motivation to leaRNThis model can be used in the educational model as they approach learning a problem-based manner through collaboration with educators and leaRN. This approach fosters the learning of the population of interested, emergency department registered nurses. These are adult leaRNs who are required to use critical thinking skills to provide care for patients in need. This learning model is necessary for the education of triage in the emergency department.</p> <p><strong>Review of Literature.</strong> The review of the literature provides evidence of the Emergency Severity Index (ESI), as refined and validated triage method which helps assess, carefully allocated and plans on the amount of resources needed to care for patients. Studies showed that triage nurses are often faced with many challenges such as lack of formal training, high patient volume, staffing, rate of ED occupancy, inpatient bed availability, interruptions, and lack of privacy. (FeRNes et al., 2005) Many studies proved formal education, emergency nursing experience for new triage nurses, and positive reinforcement from management for timely and accurate decision making showed positive outcomes for patients and staff satisfaction. (Cone and Murray, 2002) Standardized training for assessment, documentation, and ESI implementation is critical to provide consistent care. (Dateo, 2013) Several studies have continued to recognize a combination of education in simulations, thinking aloud, reflection, and incorporation of decision rules lead to a more accurate triage decisions. (Cioffi, 1999)</p> <p><strong>Methods.</strong> Nurse Practitioner will educate Registered Nurses in the emergency department on the evidence-based practice of 5 tier triage system. Education will occur via mix educational methods of a PowerPoint presentation, role-play with use of paper models, case study and preceptorship. This will be a prospective or cohort study to study the effect of nurse practitioner led educational program for registered nurses. A convenience sample of (n=30) will be used. Registered nurses will perform two exams one prior education intervention and a post-test after intervention. They will also complete a survey via Likert scale to evaluate satisfaction and effectiveness of program. Finally, participants will be observed for accuracy of triage of patients in the Emergency Department to complete necessary compentency of care of patients. Throughout the entire educational process registered nurses will be able to ask questions and be involved in an open discussion forum. Nurses will be allowed to debrief events in case studies and observational assessments of patients. Evaluation of program will occur through post-test, survey of program, appropriate triage level and disposition of patient.</p> <p><strong>Results.</strong> Pending. Preliminary data suggests improvement in nurses' knowledge of triage system and satisfaction in program.</p> <p><strong>References:</strong> Aloyce, R., Leshabari, S. &amp; Brysiewicz. (2014) Assessment of knowledge and skill of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania. African JouRN of Emergency Medicine, 4, 14-18. Benner P &amp; Tanner C. (1987) How expert nurses use intuition. 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