Electronic alerts for triage protocol compliance among emergency department triage nurses: a randomized controlled trial.
BACKGROUND
Alerts embedded in electronic health records (EHRs) are designed to improve processes at the point of care.


OBJECTIVE
The aim of this study was to determine if an EHR alert-at emergency department (ED) triage-increases the ED triage nurse's utilization of triage protocols.


METHODS
ED triage nurses were randomized to receive either a passive EHR alert or no intervention for patients with the following complaints: minor trauma with extremity injuries or female patients with abdominal pain. The EHR alert notified the nurse that the patient was eligible for diagnostic testing: radiographs for patients with injured extremities or urinalysis for female patients with abdominal pain.


RESULTS
Twenty-eight nurses triaged 20,410 patients in the 6 months before the intervention and 19,157 in the 6 months after the intervention. Before the intervention, the urinalysis protocol was implemented in 101/624 (16.2%) patients triaged by the intervention group and 116/711 (16.3%) triaged by the control group. After the intervention, the urinalysis protocol was implemented in 146/530 (27.6%) patients triaged by the intervention group and 174/679 (25.6%) triaged by the control group. Before the intervention, the radiograph protocol was implemented in 58/774 (7.5%) patients triaged by the intervention group and 45/684 (6.6%) triaged by the control group. After the intervention, the radiograph protocol was implemented in 78/614 (12.7%) patients triaged by the intervention group and 79/609 (13.0%) triaged by the control group.


CONCLUSIONS
The use of a passive EHR alert to promote ED triage protocols showed little benefit. Before the widespread implementation of EHR alerts for patient care, rigorous studies are required to determine the best alert methods and the impacts of such interventions.
James F. Holmes, MD, MPH, is Professor; and Joshua Freilich, RN, MSN, MHA, is Assistant Nurse Manager, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California. Sandra L. Taylor, PhD, is Senior Statistician, Clinical Translational Science Center, UC Davis School of Medicine, Sacramento, California. David Buettner, RN, MS, is Emergency Department Clinical Resource Nurse and Clinical Information System Analyst, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California.
James F
JF
Holmes
Joshua
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Freilich
Sandra L
SL
Taylor
David
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Buettner
D015746:Abdominal Pain / Q000652:urine; D001134:Arm Injuries / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D057286:Electronic Health Records; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging; D011859:Radiography; D017010:Reminder Systems; D014218:Triage; D016482:Urinalysis