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Impact of Triage Education on Appropriate Utilization of Trauma Activation Criteria

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Impact of Triage Education on Appropriate Utilization of Trauma Activation Criteria
Margot Daugherty, MSN, MEd, RN, CEN, Mary Frey, MSN, CNL, RN, CEN, CPEN, Suzanne Moody, MPA, CCRP and Richard A. Falcone, Jr., MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati OH

Objective:
Background: Trauma teams present at the bedside upon a patient's arrival facilitate effective team function. A review of trauma team presence in 2013 demonstrated key members were not present on patient arrival 40% of the time. In 2014, we identified that under-utilization of the trauma activation criteria by emergency department triage nurses resulted in an under-triage rate of 10.2% of mid-level trauma activations. In addition, a survey of triage nurses found physician and peer reactions were viewed as deterrents to correctly activate a trauma at the appropriate level.
Methods: The nursing triage orientation was revised to include a comprehensive trauma module that focused education on activation criteria and appropriate triage of the trauma patient. A video recording was added to the module containing leadership support of the appropriate triage of all patients into the shock trauma suite. Following implementation of the new training module under-triage rates were reevaluated. Findings were compared to the pre-implementation time period.
Results: Following implementation of the new trauma triage orientation a reduction in the under-triage rate for trauma evaluations decreased from 10.2% to 4.7% (p.0006). Post-survey results however identified a continued perceived concern about negative physician response to trauma team activation by nursing 74% vs 58.7%. The follow-up survey validates that the revised triage orientation has had a positive impact, the percentage of those not aware they could activate a trauma decreased from 7.6% to 0.0%. Conclusion: The next step is to further understand physician perception of nurse initiated trauma activation in order to reduce this identified barrier.
Objective: The participant will recognize the impact of triage education on appropriate utilization of trauma activation criteria.Objective Content: Trauma teams present at the bedside upon a patient's arrival facilitate effective team function. A review of trauma team presence in 2013 demonstrated key members were not present on patient arrival 40% of the time. In 2014, we identified that under-utilization of the trauma activation criteria by emergency department triage nurses resulted in an under-triage rate of 10.2% of mid-level trauma activations. In addition, a survey of triage nurses found physician and peer reactions were viewed as deterrents to correctly activate a trauma at the appropriate level.
Methods: The nursing triage orientation was revised to include a comprehensive trauma module that focused education on activation criteria and appropriate triage of the trauma patient. A video recording was added to the module containing leadership support of the appropriate triage of all patients into the shock trauma suite. Following implementation of the new training module under-triage rates were reevaluated. Findings were compared to the pre-implementation time period. Results Following implementation of the new trauma triage orientation a reduction in the under-triage rate for trauma evaluations decreased from 10.2% to 4.7% (p.0006). Post-survey results however identified a continued perceived concern about negative physician response to trauma team activation by nursing 74% vs 58.7%. The follow-up survey validates that the revised triage orientation has had a positive impact, the percentage of those not aware they could activate a trauma decreased from 7.6% to 0.0%. Conclusion The next step is to further understand physician perception of nurse initiated trauma activation in order to reduce this identified barrier.


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