Implementing best practice in the triage process within Mater Hospital Brisbane (MHB) Emergency Department (ED)

Luke Burgess

Background: Triage is the process by which Emergency Departments (ED) sort patients presenting for medical treatment. Increased demand for our ED service was recognised as increasing the burden upon triage. The current practice of triage in the setting was identified as an area where practice could be updated and improved. This project aimed to compare current triage practice within our ED to Evidence Based Practice (EBP) Guidelines.

Methods: The project took place in an urban ED that sees 40000 patients per year. We audited 200 episodes of triage, 100 in the pre implementation and 100 in the post implementation phase. Current practice was compared to EBP guidelines, barriers to adherence to EBP identified, and interventions were planned and implemented to address these.

Results: We included 12 audit criteria, focused on five key areas; Arrival and Triage, Documentation, Compliance with Policy, Communication, and Triage Staff. Overall 5 criteria showed improvement, 4 showed no improvement or a decline, and 2 achieved 100% adherence in both audits.

Discussion: Through this this project we have implemented a formal Clinical Support Nurse role to support the care of waiting room patients, and act as a second triage nurse during periods of high acuity. The physical triage environment in our ED has been identified as a barrier to optimal adherence to EBP guidelines, and change to this was outside the scope of this project. The project has highlighted possible discrepancies between guidelines and the reality of clinical practice, and the importance of flexibility and adaptation in practice and implementation. The project has stimulated discussion and ideas amongst staff that will guide further improvements of our triage practice and environment in the future.