RAPIT: Rapid Assessment Processes in Triage

Mrs Andrea Thawley1, Dr Christina  Aggar2,3, Mrs Noelene  Williams1

1Northern NSW Local Health District – The Tweed Hospital, Tweed Heads, Australia, 2Northern NSW Local Health District, Nursing and Midwifery Directorate, Ballina, Australia, 3Southern Cross University, Gold Coast Campus, Bilinga, Australia

Background

The role of the triage nurse is critical to patient safety and timely access to emergency care. In 2013, a review of the NSW Triage Policy resulted in NSW Health encouraging EDs to scrutinise their functions of triage and registration processes and improve patient flow. A large regional referral hospital re-structure of ‘front-end’ processes included co-location of the triage nurse and ED ward-clerk; education related to rapid triage practise; replacing the glass barrier with wire across the front of the triage desk in addition to the introduction of a senior clinician led early treatment zone (ETZ). These processes support efficient throughput to ensure patients are seen by triage on arrival  to ED with concurrent  registration and streamed to appropriate clinical areas for commencement of treatment.

Aim

The aim of this study was twofold: provide a profile of triage waiting times, pre and post implementation of the restructure to ‘front-end’ ED processes, especially for potentially life-threatening conditions; and identify nurses’ perceived educational needs.

Method

A retrospective audit 12 months pre and post implementation of the restructure process was conducted comparing:

  • ED arrival to triage times
  • Potentially life threatening presentations from arrival to clinician seen times

A questionnaire explored triage nurses’ perceived education needs.

Results

ED presentations increased from 42718 in 2012/13 to 48253 in 2014/15, an increase of 11.47%. Arrival to triage times (median) decreased 2.34 minutes and Category Three abdominal pain presentations decreased 8:00 minutes. Triage nurses (n=27) identified priority education needs that focused on “clinical tasks” such as physical assessment skills.

Conclusion

The restructure to ‘front-end’ ED process improved patient waiting times and Category Three Abdominal Pain presentations from arrival to clinician seen times. The priority education needs reported by triage nurses will inform the design of education to support the development of nursing workforce capability.


Biography:

Andrea has a clinical background in both Intensive Care and Emergency Nursing with a Graduate Diploma in Critical Care and Masters in Advanced Nursing Practice – Critical Care. She has over 17 years ED experience in both clinical nursing and management and is currently employed by Northern NSW Local Health District (NNSWLHD) as a Clinical Nurse Consultant (Emergency) providing leadership and consultancy services for The Tweed, Byron Central and Murwillumbah Hospitals.

This project has been part of Andrea’s work for the Rural Research Capacity Building Program overseen by HETI.