Improving Triage Accuracy: A Staff Development Approach

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The purpose of the process improvement initiative was to improve the percentage of undertriaged patients to less than 10% (benchmark) using the Emergency Severity Index tool. Undertriaged patients have an increased potential for poor outcomes due to a lengthier waiting room stay, which results in delay of care.

Description of the Project:

An evidence-based project designed for staff development was conducted for a 7-month period. Project procedures consisted of triage chart reviews for a 3-month period during pre– and post–Emergency Severity Index training. Emergency Severity Index refresher training for nurses triaging in the emergency department was conducted for a 1-month period.


Chart reviews revealed that 102 of 388 patients (26.3%) were undertriaged before Emergency Severity Index training. After Emergency Severity Index training, chart reviews depicted that 41 of 440 patients (9.3%) were undertriaged. This difference was statically significant (P < .001), when tested using a 1-sided t test at the 95% confidence level and achieving at least 80% power.


Regardless of previous training or years of emergency department nursing experience, triage refresher training has been shown to increase accuracy of triage categorization, thus leading to a decreased risk of poor patient outcomes.

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