PICO RESEARCH, DISSEMINATION OF EVIDENCE PAPER

paper is about a nurse driven topic. The first Part I turned in with the PICO
components of Population : patients presenting to emergency department, Intervention: being triaged by a nurse , Comparison: having no triage nurse, Outcome: expedites access to care. PICO question is : In patients presenting to the ED, does having a triage nurse compared to no triage nurse expedite the patient’s access to care. I have attached one article that the teacher has approved of but still need 2 more related to the topic.

ANSWER

PICO Research

Introduction

The hospital emergency department is one of the most crucial components of the health delivery systems. Emergency departments have been reported in serving an increase in numbers of patients with an array of problems from life-threatening, urgency to mild problems. All the patients that arrive in the emergency room need to be identified and classified to prioritize those that have more urgent medical issues and need immediate care. The triage process in medical care is classified as categorizing patients by nurses in the ED. The triage process is usually conducted by nursing staff who initiate the emergency care and allocation of triage designation before the doctor examines the patient. The nurses carry out the triage assessment and make decisions about the nurse’s severity and medical conditions. Nursing triage practice offers accurate and clinical reasoning and decision making skills

Triages entail checking the patient’s clinical severity, time urgency, and comparison to the patients to ensure that the treatment interventions are not delayed. The objective of triage in the ed is to distribute the workload and utilize resources better efficiently. The triage system has been utilized by redistributing resources, admission rates, reducing time wastage, and improving healthcare quality. It is essential to understand the triage process and the importance of this process in the clinical setting. Various studies have examined the importance of triage systems in improving patient flow in the healthcare setting.

PICO Components and Clinical Question

Problem

The emergency department (ED) has been presented with challenges that demand nursing professionals evaluate health care practices continually. Overcrowding in the ED has become an ever-increasing problem in most hospital settings. Overcrowding within the emergency department occurs when the demand for services in the emergency department exceeds the number of health practitioners available to serve the patients (Zachariasse et al., 2019). Additionally, overcrowding has also been a result, emergency departments failing to conduct a rapid medical examination, initiating diagnostic studies that will expedite the care. The flow of patients within the emergency departments has been influenced by the length of stay and delays in early patient therapy initiation. This has led to a lack of effective treatment and critical care patients receiving interventions in time.

The patient assignment category process has been a significant limitation in the emergency department due to the lack of a sufficient criterion of presenting the clinical urgency. Overcrowding in the ED demands a precise triage decision that facilitates the effective delivery of care to the patients in a time-sensitive manner. Additionally, the direct bedding process has led to increased patient complaints, inadequate treatment, patient safety risks, and patient dissatisfaction. The current treatment protocols demand examination and review to ensure that best practices have been integrated.

Intervention

The patients that are present at the emergency department expect to be treated and their health problems addressed in a timely fashion. The triage system has been utilized in most emergency departments to promptly provide the best care to patients and improve the effective allocation of resources in the emergency department. The emergency departments have triage systems that have been put in place to facilitate or improve patients’ prioritization. Over the years, various formal triage scales have been established to standardize the approach and effectively distinguish between the low and high urgency patients. To facilitate improved health care, triage practices are necessary for evaluating the severity of clinical intervention. Early recognition of high-risk patients within the emergency department and accurate utilization of resources is essential for effective outcomes. The triage systems facilitate the delivery of timely care and mitigating overcrowding in the emergency department.

Comparison

The comparison to the current practice is the nurses not to follow the triage protocol. Mistriage occurs when the nurses fail to use the triage protocol, which leads to over or underestimation of injury, illness, and condition. Mistriage has led to increased delay to access to care, which has further led to an overcrowding crisis in the emergency department due to poor health outcomes and negative care. This will have different outcomes as compared to when the nurses conduct the triage protocol. Considerably, the triage process influences patient satisfaction, delayed care, risk of insufficient outcomes, and higher patient mortality.

Outcome

Nurse triages aimed to redistribution of workload to expedite access to care. Overcrowding threatens the patient population safety as well as the objective of the nurse to improve the quality and outcomes of healthcare. Ideally, the issue is not reduced or increasing the waiting times but facilitating the overall effectiveness of the health outcomes (Haybarker, 2015). There has been numerous evidence from supporting articles that have shown the effectiveness of implementing the triage protocols. Triage systems have been used to prioritize low and high urgency patients as well as the allocation of resources in the emergency department to facilitate effective treatment and performance in the ED (Harding, Taylor and Leggat, 2011). The triage process reduces the total patients that go without being seen due to more waiting time, and reduced length of stay. Therefore, triage protocols are effective in expediting care and improving patient flow.

Clinical Question

The clinical question is: In patients presenting to the ED, does having a triage nurse compared to no triage nurse expedite the patient’s access to care? The PICO research is aimed at understanding the difference between implementation and lack of implementation of the triage process in expediting care through effective estimation of the patient condition severity. The clinical questions will illustrate the effectiveness of triage protocols in the ED.

The Literature Search Process

The sources of evidence were searched from Medline (EBSCO), PubMed the Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Agency for Healthcare and Research Quality (AHRQ).  The searches were limited to articles that were published in English and search terms that enabled yield pertinent information. To limit the number of article results, the literature search included two search terms “triage” and “emergency department,” which are related to the triage process in the hospital settings.

The exclusion and inclusion criteria for the articles included relevant articles that were published between 2010-2020. The search was further limited to Meta-Analysis, Systematic Review, Randomized Control Trial, Quality Improvement Project, Original/Primary Study/Research, Evidence-Based Practice Project, and Literature or Integrative Review. Twenty articles were initially reviewed before choosing the three most appropriate articles for the topic. An abstract overview was conducted to evaluate the relevance of the article and the hierarchy of evidence.

References

Harding, K. E., Taylor, N. F., & Leggat, S. G. (2011). Do triage systems in healthcare improve patient flow? A systematic review of the literature. Australian Health Review, 35(3), 371-383.

Haybarker, B. D. (2015). Reducing emergency department length of stay by system change.

Zachariasse, J. M., van der Hagen, V., Seiger, N., Mackay-Jones, K., van Veen, M., & Moll, H. A. (2019). Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open, 9(5), e026471.