Triage quality control is missing tools-a new observation technique for ED quality improvement.
OBJECTIVE
Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods.


METHODS
The study developed an observation technique for identifying patients with possible erroneous assessments in triage. Data sample for the observation technique is carried out with survey form filled in by nurse.


METHODS
Hospital ED with ~74 000 patient visits annually.


METHODS
Consecutive adult patients in an ED for baseline study period of 14 days (1774 patients) in 2010 and control study period of 4 days (541 patients) in 2012.


METHODS
Triage observation technique for continuous improvement of triage performance.


METHODS
Primary measures of triage improvement were triage accuracy and nurses' ability to predict patient admissions.


RESULTS
With the observation technique the ED staff was able to identify patient groups at risk for erroneous triage. Under-triage related mostly to patients with chest pain, shortness of breath, collapse, stomach pain and infections. Instead injures and muscular skeletal symptoms were seldom undertriaged even though they are common.


CONCLUSIONS
EDs can control triage quality with simple observation technique. The usability of observation technique and triage quality improvement process were good.
Department of Industrial Engineering and Management, Aalto University, Otaniementie 17, PO Box 15500 Espoo, Finland.
Tomi
T
Malmström
Division of Emergency Care, Helsinki University Central Hospital, Stenbäckinkatu 9, PO Box 100 Helsinki, Finland.
Veli-Pekka
VP
Harjola
Department of Industrial Engineering and Management, Aalto University, Otaniementie 17, PO Box 15500 Espoo, Finland.
Paulus
P
Torkki
Division of Emergency Care, Helsinki University Central Hospital, Stenbäckinkatu 9, PO Box 100 Helsinki, Finland.
Salla
S
Kumpulainen
Hospital District of Helsinki and Uusimaa, Joint Authority, Stenbäckinkatu 9, PO Box 100 Helsinki, Finland.
Raija
R
Malmström
D000293:Adolescent; D000328:Adult; D000368:Aged; D016529:Emergency Nursing / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods*
emergency care < setting of care; patient safety; quality improvement < quality management; quality management