Clinical Decision Support Systems in the Emergency Department: Opportunities to Improve Triage Accuracy

Triage decisions are made under time pressure, utilizing limited information, in an environment rich with interruptions and other unpredictable factors. The triage nurse’s decision about the acuity, or risk level, for each patient has multiple consequences, including the patient’s initial prioritization of care and his or her room placement within the emergency department; it also has an effect on the amount of time that elapses before the patient is assessed by a provider. Accurate triage decisions are essential for successful ED operations and for optimizing patient outcomes. Although the phrase “triage accuracy” lacks a universal definition, typically it is considered to be the assignment of an “appropriate” acuity score or risk level using a validated triage scale, compared with an expert opinion or final diagnosis. Certain patient populations such as children, patients with chronic illnesses, and women or elderly persons with acute myocardial infarction can be particularly challenging to assess because of atypical or subtle presentations for some acute and life-threatening conditions. Pediatric patients historically have had a lower level of consistency in triage decisions, and up to 50% of patients with acute myocardial infarction are undertriaged or assigned an acuity level that is lower than what it should be based on their final diagnosis. Mis-triage is a problem among nurses of all experience levels and can lead to dangerous delays in care.