Sunday, November 2, 2003

This presentation is part of : Innovations in Trauma and Triage Techniques and Care

Moving to Evidence-Based Practice in Emergency Department Triage: An Interdisciplinary Approach to Change

Tania D. Strout, RN, BSN, Emergency Department, Maine Medical Center, Portland, ME, USA, Michael R. Baumann, MD, FACEP, Department of Emergency Medicine, Maine Medical Center, Portland, ME, USA, and Alyce A. Schultz, RN, PhD, Maine Medical Center, Portland, ME, USA.
Learning Objective #1: Discuss how clinical practice and scholarship are linked in this move to evidence-based practice
Learning Objective #2: Discuss the value of creating interdisciplinary teams for policy making in clinical practice

A majority of United States emergency departments (ED) utilize a comprehensive triage system. With this system, a registered nurse (RN) obtains vital signs, medication and allergy history, history of presenting illness, and physical exam before assigning a triage category. In our Level 1 tertiary care ED, RNs, physicians (MD), and patients (pts) expressed dissatisfaction with this traditional triage system. Horsley, Crane, and Bingle's model for research-based innovation in nursing practice served as the framework for this collaborative project. RNs and MDs expressed interest in moving to an evidence-based triage system. An interdisciplinary team was developed for the purpose of investigating the possibility of identifying and implementing such a system utilizing a planned change model for research-based innovation in practice. Following the steps in the model, the team identified concern for changing triage practice, defined and assessed the patient care problem, and initiated a search for solutions. A review of the literature was conducted utilizing MEDLINE and CINAHL. Twenty-nine articles pertaining to triage were identified and critiqued by RN and MD partners utilizing the Stetler method. Results of the critique identified a new triage system, the Emergency Severity Index (ESI) as a potential solution to the nursing practice and patient care problems identified by the team. Currently, the team is educating all ED staff on the ESI in established forums such as interdisciplinary journal clubs. A system for implementation and evaluation of the change has been developed and will be presented. We conclude that utilization of a collaborative approach to evidence-based practice change is an effective method for discovering the need for change, defining patient care problems, and identifying solutions to clinical problems. Drawing on the distinct backgrounds of our disciplines allows RNs and MDs to partner in a collaborative way to more fully link practice and scholarship in clinical settings.

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