title: A preliminary study of a novel emergency department nursing triage simulation for research applications.
abstract: BACKGROUND
  Studying the effect on functioning of the emergency department of disasters with a potential impact on staff members themselves usually involves table top and simulated patient exercises. Computerized virtual reality simulations have the potential to configure a variety of scenarios to determine likely staff responses and how to address them without intensive utilization of resources. To decide whether such studies are justified, we determined whether a novel computer simulation has the potential to serve as a valid and reliable model of on essential function in a busy ED.
  
  
  METHODS
  Ten experienced female ED triage nurses (mean age 51) mastered navigating a virtual reality model of triage of 4 patients in an ED with which they were familiar, after which they were presented in a testing session with triage of 6 patients whose cases were developed using the Emergency Severity Index to represent a range of severity and complexity. Attitudes toward the simulation, and perceived workload in the simulation and on the job, were assessed with questionnaires and the NASA task load index. Z-scores were calculated for data points reflecting subject actions, the time to perform them, patient prioritization according to severity, and the importance of the tasks. Data from questionnaires and scales were analyzed with descriptive statistics and paired t tests using SPSS v. 21. Microsoft Excel was used to compute a correlation matrix for all standardized variables and all simulation data.
  
  
  RESULTS
  Nurses perceived their work on the simulation task to be equivalent to their workload on the job in all aspects except for physical exertion. Although they were able to work with written communications with the patients, verbal communication would have been preferable. Consistent with the workplace, variability in performance during triage reflected subject skill and experience and was correlated with comfort with the task. Time to perform triage corresponded to the time required in the ED and virtual patients were prioritized appropriately according to severity.
  
  
  CONCLUSIONS
  This computerized simulation appears to be a reasonable accurate proxy for ED triage. If future studies of this kind of simulation with a broader range of subjects that includes verbal communication between virtual patients and subjects and interactions of multiple subjects, supports the initial impressions, the virtual ED could be used to study the impact of disaster scenarios on staff functioning.
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA. dubovsky@buffalo.edu.|Departments of Psychiatry and Medicine, University of Colorado, Aurora, CO, USA. dubovsky@buffalo.edu.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Dubovsky
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Antonius
authors.affiliation: Department of Emergency Medicine, University at Buffalo, 462 Grider St, Buffalo, NY, 14215, USA.|, 462 Grider St, Buffalo, NY, 14215, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Ellis
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.|Department of Biomedical Informatics, University at Buffalo, 701 Ellicott St, Buffalo, NY, 14203, USA.
authors.forename: Werner
authors.initials: W
authors.lastname: Ceusters
authors.affiliation: School of Dental Medicine, University at Buffalo, 462 Grider St, Buffalo, NY, 14215, USA.|, 4455 Genesee St, Buffalo, NY, 14225, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sugarman
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.|, 462 Grider St, Buffalo, NY, 14215, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Roberts
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.|, 462 Grider St, Buffalo, NY, 14215, USA.
authors.forename: Sevie
authors.initials: S
authors.lastname: Kandifer
authors.affiliation: Full Circle Studios, 710 Main St, Buffalo, NY, 14202, USA.
authors.forename: James
authors.initials: J
authors.lastname: Phillips
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.|, 462 Grider St, Buffalo, NY, 14215, USA.
authors.forename: Elsa C
authors.initials: EC
authors.lastname: Daurignac
authors.affiliation: Department of Psychiatry, University at Buffalo, 462 Grider St, Room 1182, Buffalo, NY, 14215, USA.|Research Institute ON Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Leonard
authors.affiliation: School of Social Work, University at Buffalo, 685 Baldy Hall, Buffalo, NY, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Butler
authors.affiliation: Department of Biomedical Informatics, University at Buffalo, 701 Ellicott St, Buffalo, NY, 14203, USA.|School of Nursing, University at Buffalo, 212 Wende Hall, Buffalo, NY, USA.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Castner
authors.affiliation: Department of Emergency Medicine, University at Buffalo, 462 Grider St, Buffalo, NY, 14215, USA.|, 100 High St, Buffalo, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Richard Braen
mesh_terms: D000328:Adult; D003142:Communication; D003362:Cost-Benefit Analysis; D004506:Education, Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D009729:Nursing / Q000379:methods*; D016544:Patient Simulation; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage / Q000379:methods*
keywords: Computer; Disaster; Emergency department; Simulation