Strategies to improve the quality of nurse triage in emergency departments: A systematic review

Aim: This systematic review aimed to assess the impact of implementation strategies for nursing triage on quality outcomes and to examine barriers and facilitators to their implementation in the emergency department (ED). Data sources: Embase, PubMed, CINAHL, Cochrane Library, Web of Science, PsycINFO and ProQuest Dissertations & Theses. Methods: This systematic review included quantitative and qualitative studies published from January 1990 to April 2024 that evaluated strategies to improve ED triage. Study quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The benefits of the strategies were reported using descriptive statistics (quantitative studies) and themes and subthemes (qualitative studies). Barriers and facilitators were identified using the Behavior Change Wheel framework. Result: Three main implementation strategy categories to improve the quality of nursing triage were identified: education (64%), technology (30%), and audit and feedback (6%). All strategies demonstrated short-term benefits, including increased triage accuracy and improved triage knowledge and skills. The most frequently reported barriers were workload and overcrowding, while facilitators included nurses' experience, interprofessional collaboration, and a culture of continuous improvement. Conclusion: Comprehensive approaches, including education, technology, and regular audits with feedback, are associated with improved triage quality outcomes. Continuous training, active nurse participation in tool development, and the use of validated audit tools are essential. These measures could ensure rigorous nursing triage in EDs and enhance care safety by optimizing patient prioritization as they enter healthcare systems. This review underscores the need for further research on implementation strategies to enhance effective and safe patient prioritization in the ED.