Development of a Toolkit for Ordering Timely Diagnostic Testing and Treatments in the Emergency Department Triage

Background: The COVID-19 pandemic has led to many turnovers of nursing staff at the emergency departments (ED). This has led to various new staff with different experiences joining the ED team and placing new staff members in the triage role. Many new ED nurses need to familiarize themselves with the role and how to correctly order timely diagnostic testing and treatments while the patients wait for a room. Local Problem: Lack of experienced nurses in the University of Utah Hospital ED triage has created issues with ordering timely and appropriate diagnostic testing and treatments for patients interrupting the workflow process flow. Interventions: A needs assessment to understand gaps in knowledge related to new nurses (less than one year) placed in the triage role. Based on those results, a Triage Toolkit was developed based on chief complaints that were difficult to order. Methods This quality improvement project was conducted at the University of Utah ED between September 2023 to March 2023. Data were collected from ED nurses including a competency assessment (surveys and semi-structured interviews). Questions included nurses' working experience, their comfort level with the role in triage (using a scale of 0-10, higher score indicating a higher comfort level), their comfort level of ordering diagnostic testing or treatments (using a scale of 0-10), and competency in ordering for different chief complaints. Descriptive data analysis was used to explain the findings, including a Mann-Whitney U test due to the small sample size. After developing the Triage Toolkit, a System Usability Scale assessment and semi- structured interviews were conducted on the nurses based on the Triage Toolkit. Results: Of the 123 surveys sent out, 48 nurses responded, with a return rate of 39% with 18 newer nurses (in the ED less than or equal to one year) and 30 experienced nurses (greater than one year in the ED). Experienced ED nurses were more comfortable in triage (p<.001) and in ordering diagnostic tests or treatments in triage (p<.001). More than half of the newer ED nurses felt less comfortable ordering diagnostic testing or treatments. Newer presented with lower scores on the competency assessment. To examine the useability and satisfaction of the toolkit, semi-structured interviews and system usability scale assessment were conducted with 10 nurses (seven new nurses and three experienced nurses). Overall, they were satisfied with the toolkit and ranked the Triage Toolkit highly on the system usability scale. Conclusions: This project identified many knowledge gaps based on experiences. A Triage Toolkit was developed to fulfill those gaps. The next step of the project would be to implement the toolkit.