Improving optimal decision making processes by emergency registered nurses and first responders

When assistant professor Gudrun Reay attended a conference where physicians presented research about emergency department (ED) triage, it prompted her to think about her own 20-year experience as an ED triage RN.

“I wanted to know how nurses make decisions in complex areas, like triage, where patients’ lives can be at stake. I was not so much interested in acuity scales; I wanted to know what choices RNs are considering when they are triaging patients,”she says.

Reay’s curiosity is now her research emphasis as an academic. “In my first study, the results showed that triage RNs spend a large amount of time shuffling patients. It is not just a question of how sick a patient is — nurses know sick: decisions are all around managing space, anticipating needs and creating space while all the while determining acuity.”

Reay then moved on to paramedics and how they make decisions in the field. “Paramedics operate in a very fluid environment,” she explains. “In many cases, they are going into environments where the scene dictates what they can and can’t do. They also have access to lots of rich information from that environment. The triage nurses don’t have the same access. When the patient arrives in the ED and transitions into the care of the hospital, there needs to be an accurate exchange of information between the paramedics and nurses to ensure the safety and continuity of patient care.”

Reay and her research team just wrapped up the analysis of data from a number of focus groups and will develop a questionnaire that measures how triage RNs make decisions using factors that nurses themselves have identified. Eventually the questionnaire will be distributed nationally to triage professionals.

“I am hopeful the results can be used to think about how we need to design ED triage areas — how waiting rooms need to be set up with clear sightlines, for example — and what sort of software we need to better communicate within the team.”