title: Perspectives of emergency department staff on the triage of mental health-related presentations: Implications for education, policy and practice.
abstract: OBJECTIVE
  To explore ED staff perceptions of the factors that influence accuracy of triage for people with mental health problems.
  
  
  METHODS
  This qualitative learning needs analysis used a descriptive exploratory design. Participants were Australian emergency nurses and doctors. We used a criterion-based sampling approach. Recruitment was facilitated by the College of Emergency Nursing Australasia and the Australasian College for Emergency Medicine. A semi-structured interview schedule was developed. Telephone interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to identify factors perceived to affect triage outcomes and to explore strategies to optimise the accuracy of triage assessments.
  
  
  RESULTS
  Thirty-six staff participated (16 nurses and 20 doctors). Four major factors were perceived to influence accuracy. These were: environmental factors (physical structure, time pressures, activity levels, and interruptions), policy and education (guidelines, training and resources), staff factors (knowledge, experience, attitudes) and patient factors (police presence, patient behaviour, clinical condition). Differences of opinion were expressed by emergency doctors about the validity of the time to treatment objectives included in the Australasian Triage Scale for mental health presentations, and the utility of the scale to differentiate urgency for psychiatric conditions.
  
  
  CONCLUSIONS
  Clinical guidelines and training have been developed to support the use of the Australasian Triage Scale. Further evaluation of the application of this scale to assess mental health problems is indicated. Additional work is also required to reduce variance in urgency assignment based on staff knowledge and attitudes about the causes, assessment and early management of psychiatric disorders.
authors.affiliation: Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia. marie.gerdtz@mh.org.au
authors.forename: Marie F
authors.initials: MF
authors.lastname: Gerdtz
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: George A
authors.initials: GA
authors.lastname: Jelinek
authors.forename: Claire
authors.initials: C
authors.lastname: Mackinlay
authors.forename: Nicole
authors.initials: N
authors.lastname: Hill
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D008505:Medical Staff, Hospital; D001523:Mental Disorders / Q000175:diagnosis*; D008603:Mental Health; D020380:Needs Assessment; D016134:Organizational Policy; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011787:Quality of Health Care; D012931:Social Environment; D012938:Social Perception; D014218:Triage / Q000379:methods*