Implementation of a Continuing Education Module on Triage Practices for Pediatric Emergency Room Nurses

BACKGROUND: More than 35 million U.S. children visit the emergency department (ED) each year. Triage is the family’s first interaction with the healthcare team and a crucial component of care that directs the course of the ED visit. The use of standardized triage protocols, like the Emergency Severity Index (ESI) algorithm, is shown to improve overall patient health outcomes in the pediatric ED. For triage algorithms to be safe and effective, continuing education for pediatric ED nurses is important.

LOCAL PROBLEM: Patients at a local pediatric emergency department are being inaccurately triaged - assigned a higher or lower acuity level than their condition warrants. This leads to patient decompensation while waiting to be seen by a provider, increased department wait times, and decreased family satisfaction.

METHODS: The Plan-Do-Study-Act (PDSA) model for improvement was used to guide project development and implementation. Patient charts were audited using an EMR scoring tool developed by the project team reflecting anticipated resources, initial vital signs, and patient condition change during ED course.

INTERVENTIONS: A continuing education module (CBL) on triage practices was developed and implemented. The module was open for all pediatric ED nurses to complete at the project site. Components of the CBL module included a review of the ESI algorithm, pediatric triage practices, department resources, stable and unstable vital signs, and patient case studies.

RESULTS: Emergency department triage accuracy improved from 83.6% accuracy to 87.7% accuracy. This 4.1% increase demonstrates clinical significance of practice improvement.

CONCLUSIONS: The implementation of a continuing education module on triage practices in the pediatric emergency department leads to improved triage accuracy among pediatric emergency room nurses. Regular implementation of a CBL may continue to improve triage accuracy and lead to decreased ED wait times and improved family satisfaction.