Increasing Effective Patient-Triage Nurse Communication Using a Targeted History Question.

摘要

This quality improvement project identified a need to improve patient placement between the Fast Track and the Emergency Department treatment areas of an urban Southern Arizona hospital. The current triage process at this hospital excludes patient past medical history, limiting the information given to triage nurses when assigning patient acuity scores and determining placement in the ED. This project sought to improve patient to nurse communication during the triage interview process by educating nurses to ask a 'targeted history' question: a question created to obtain concise past medical history information related to the patient's chief complaint. This targeted history question was worded as "Have you been treated for [chief complaint] before?" Chart audits were performed to gather quantitative data on patient placement, ESI scores, triage interview times, and nursing compliance rates. Stakeholders were also asked open-ended questions regarding their perceptions of triage and the integration of the targeted history question. These interviews were recorded, transcribed, and coded for common categories. Results show low nursing compliance with asking the targeted history question. However, almost two-thirds of triage notes mentioned some form of past medical history---showing that triage nurses assess for pertinent past medical history without prolonging total triage times. Additionally, stakeholder interviews showed healthcare personnel felt the targeted history question helped with gathering useful information and patient placement, and that past medical history is an important part of triage.