Danielle Crouse

Staff nurse in the Emergency Department

The Emergency Severity Index (ESI) is recognized as a valid and reliable five-level emergency department (ED) triage tool, which can improve quality of patient care (Gilboy, Tanabe, Travers, & Rosenau, 2012). Many factors, however, influence the accuracy of ESI acuity assignment by nurses so continued education and evaluation is essential for quality improvement. Incorrect triage acuity assignment, known as mis-triage, can place patients at risk for deterioration and lead to valuable hospital resources being wasted. This Doctoral of Nursing Practice (DNP) quality improvement (QI) project aimed to evaluate the accuracy of ESI triage acuity assignment by nurses working in a rural Midwest ED, and determined if there was a need for process improvement. Retrospective chart reviews were conducted after the nurses completed a mandatory online-triage education program. Data collection focused on the triage portion of the ED medical record examining the accuracy of acuity assignment during triage, including the misclassification of under-triage and over-triage. A total of 115 retrospective chart reviews was conducted. Triage acuity scores were accurately assigned by nurses 66.1% of the time, missing the goal of an accuracy rate of 85% or higher. Of the misclassification of acuity assignments; 22.6 % were over-triaged, and 11.3% were under-triaged. Shift level and pediatric population did not have a significant impact on mis-triage of acuity scores. However, elderly patients over the age of 65, were misclassified 50% of the time; 28.1 % were under-triaged, and 21.9% were over-triaged. Findings of this project suggest that continued education and monitoring of triage accuracy is warranted at this facility, with particular attention to the elderly population.