Triage in Health Department of Western Australia accident and emergency departments

182 Pages·2017·4.55 MB·English

EEddiitthh CCoowwaann UUnniivveerrssiittyy
RReesseeaarrcchh OOnnlliinnee
Theses: Doctorates and Masters Theses
1-1-1995
TTrriiaaggee iinn HHeeaalltthh DDeeppaarrttmmeenntt ooff WWeesstteerrnn AAuussttrraalliiaa aacccciiddeenntt aanndd
eemmeerrggeennccyy ddeeppaarrttmmeennttss
Geraldine M. Riordan
Edith Cowan University
Follow this and additional works at: https://ro.ecu.edu.au/theses
Part of the Nursing Commons
RReeccoommmmeennddeedd CCiittaattiioonn
Riordan, G. M. (1995). Triage in Health Department of Western Australia accident and emergency
departments. https://ro.ecu.edu.au/theses/1182
This Thesis is posted at Research Online.
https://ro.ecu.edu.au/theses/1182
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USE OF THESIS

The Use of Thesis statement is not included in this version of the thesis.
Triage inD epHaertamloetfnhW t e stern
AustrAaclciiad aenndEt m ergency
Departments
By
Geraldine Mary Riordan R.N., Post-Grad. Dip. Hlth. Sc. (Nursing)
A Thesis Submitted in Partial Fulfilment of the Requirements
for the Award of
Master of Nursing
at the School of Nursing, Edith Cowan University.
Date of submission: 22nd June 1995
ii
Abstract
A survey of triage systems used in Health Department of Western
Australia accident and emergency departments was undertaken to examine
differences in practices between departments with and without designated
triage nurses (TNs). One questionnaire surveyed 93 nurses in seven
departments with TNs, a similar second questionnaire surveyed 89 nurses in
16 departments without TNs, and a third questionnaire was used in a
structured telephone interview of receptionists in hospitals without TNs. Data
were analysed using frequencies, percentages, means, standard deviations
and ranges with common themes identified for open ended questions. The
study was guided by Donabedian's systems evaluation model. The structures
and processes of triage within each department were examined in relation to
the outcome standards recommended by the Australian Council on
Healthcare Standards. The study results revealed that triage nurses were
employed in all departments where patient attendances exceeded 300 per
week and nursing staff coverage in the department was higher than five per
day. Three departments had introduced triage on weekends only, and these
departments had the lowest nurse-patient ratio of one nurse per day to 7 4
patients per week. The highest nurse-patient ratio was in departments with
TNs (1-35). Conclusions drawn from the findings suggest that when
receptionists are the first person to see patients, they triage patients using
an unsatisfactory two category priority system. The average waiting time to
see nursing staff is too long in departments without TNs, 7.6 minutes, as
compared to 3. 7 minutes in department with TNs. Nursing staff perceived that
iii
triage systems could be improved by having only experienced staff as the
triageur. The surveillance of patients entering the department is unsatisfactory
as 81 % of departments without TNs and 43% of departments with TNs are
unable to provide nurse surveillance. The surveillance of the waiting room is
similarly unsatisfactory in many departments. All triage areas are inadequate,
as facilities for private conversation, hand washing and physical assessment
are not always available. The majority of departments without TNs do not have
a satisfactory triage priority category system in place. The average time taken
by nursing staff to triage patients is an acceptable 3.2 minutes in departments
with TNs, and 5.3 minutes in departments without TNs. The practice of
redirecting patients away from the department could compromise patient
safety as patients are redirected away from most departments by any level of
staff employed in the department, without any written documentation kept or
any written criteria for the redirection of these non-urgent patients. The
practice of ordering investigations and treating minor problems without
referring to a doctor could also compromise patient safety, as most
departments do not have written policies and guidelines to cover this practice.
Most departments offer an inadequate triage training program of preceptoring
only. Recommendations are focused on the reviewing of existing triage
practices to comply with the standards identified.
iv
Declaration
I certify that this thesis does not incorporate without acknowledgment any
material previously submitted for a degree or diploma in any institution of
higher education; and that to the best of my knowledge and belief it does not
contain any material previously published or written by another person except
where due reference is made in the text.
S�nature ....
./:l.::9:..6.l :::.. ...... ............... .
Date ............
V
Acknowledgments
I wish to thank the following people for their support and assistance with
this study.
My appreciation goes to my supervisor, Professor Anne McMurray for her
guidance and encouragement throughout the whole study. Also to Maxine
Serrell, lecturer Edith Cowan University, for her help in the latter stages of the
study, to Adrienne Montgomery, lecturer Edith Cowan University, for her
supervision in the early stages and to Dr Amanda Blackmore, Research
Consultant at Edith Cowan University, for her advice and assistance with the
compilation of the questionnaire and data analysis.
To all the nurses who participated in the pilot study and the main study
and to those who assisted in the distribution of the questionnaires, my sincere
thanks. Without you this study would not have been possible.
To Beverley Bradshaw for her encouragement and her assistance with a
computer, special thanks.
Finally I would like to thank my husband, Bob, and my children, Jacinta,
Anne, Matthew and John, for their support, encouragement and patience,
without which I would never have completed this study.
vi
TABLE OF CONTENTS
Page
Abstract ii
Declaration iv
Acknowledgments V
List of Tables ix
List of Figures xii
CHAPTER ONE - Introduction 1
Background 2
Significance 5
Purpose 6
Research Question 6
Definition of Terms 7
Organisation of Thesis 9
CHAPTER TWO - Literature Review 10
Rationale for Triage 10
The Triageur 15
Activities and Functions of the Triageur
20
Organisation of Services
27
Summary 28
CHAPTER THREE - Conceptual Framework 30
Donabedian's Systems Evaluation Model 30
Systems Evaluation Model for Triage 31
CHAPTER FOUR - Method 35
Sample
36
Design
37
Instrument 38
Pilot study 40
Changes to Questionnaires Following Pilot Study 41
Reliability and Validity
42
vii
CHAPTER FOUR(continued) Page
Procedure
43
Data Analysis
43
Ethical Considerations 44
Assumption 45
Limitations 45
Summary 45
CHAPTER Five - Findings 47
Respondents 48
Subsidiary Question 1. What are the differences in staffing
levels between accident and emergency departments with
and without designated triage nurses? 51
Subsidiary Question 2. What are the differences in patient
attendances between accident and emergency
departments with and without designated triage nurses? 53
Subsidiary Question 3. What are the differences in the way
triage services are organised between accident and
emergency departments with and without designated
triage nurses? 55
Subsidiary Question 4. What are the differences in triage
practices between accident and emergency departments
with and without designated triage nurses? 59
Subsidiary Question 5. What are the differences in the
preparation of triage nurses between accident and
emergency departments with and without designated
triage nurses? 82