International Emergency Nursing 59 (2021) 101069

Contents lists available at ScienceDirect

International Emergency Nursing

journal homepage: www.elsevier.com/locate/aaen

Emergency nurse triage in the hospital information management system: A

quality improvement study
Songül Bişkin Çetin a, Fatma Cebeci a, *, Oktay Eray b, Mustafa Coşkun c, Meral Gözkaya d
a
Faculty of Nursing, Surgical Nursing Department, Akdeniz University, 07058 Campus, Antalya, Turkey
b
Departments of Emergency Medicine, Faculty of Medicine, Akdeniz University Hospital, Antalya, Turkey
c
Medical Informatics Specialist, Akdeniz University Hospital, Antalya, Turkey
d
Director of Nursing Emergency Department, Akdeniz University Hospital, Antalya, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Assessment of nurse triage decision accuracy and triage times is currently carried out through paper-
Triage based methods. This quality improvement study aims to develop a method that can assess the accuracy and
Nurse duration of nurse triage decisions based on a computerized system and to share an example of the application of
Quality Improvement
this method.
Emergency Department
HIM
Methods: This is a descriptive quality improvement study. The study was carried out in two stages between March
and May 2019. The functionality of the developed method was examined using 3835 patients’ triage data, which
were obtained between June 1 and 14, 2019.
Results: With this study, the determination of the accuracy and duration of nurse triage decisions was accom­
plished with a computerized process based on real patient outputs, and the accuracy and duration of these de­
cisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The
functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate
was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all
triage nurses.
Conclusion: The study result outputs can be integrated into quality processes and can be used internationally as
performance assessment criteria and quality indicators for triage nursing.

1. Introduction
Triage has proven to be clinically valuable as an integral part of
emergency services worldwide [1]. The accuracy of triage decisions can
represent the quality of emergency services [2]. For the triage decision
to be accurate and reliable, the use of electronic triage systems should be
encouraged [3], and the triage performance of nurses should be evalu­
ated and improved [2,4]. There are some studies in the literature that
evaluate triage decision accuracy [5,6,7,8] and duration [9,10]. In
studies conducted to evaluate the accuracy and duration of triage de­
cisions, it has been observed that the assessments are carried out using
tables or paper-based observations [9,10], and the decision accuracy is
approved by specialist triage nurses or emergency physicians [6,8].
However, paper-based methods are time-consuming and susceptible to
human errors [11].
A low rate of adverse events is one of the indicators of the quality of
emergency services [2]. Therefore, high accuracy of triage decisions
represents the quality of the emergency service [2]. Constant quality
improvement, supervision, monitoring, and intervention studies are
required to strengthen the use of triage systems [2], to enhance the
accuracy of triage decisions [12], and to improve nurses’ triage per­
formance [2,12]. In this context, the use of innovative techniques to
provide objective criteria to healthcare workers in emergency room
triage is highly important[13]. It has been stated that information
technologies and systems can be utilized in quality improvement pro­
cesses [4].
Studies have revealed the need for quality improvement, monitoring,
and supervision to increase triage accuracy [2,12]. However, there are
no studies in the international literature that provide a sustainable and
objective method that can be followed to assess the accuracy of triage

* Corresponding author.
E-mail addresses: songulbiskin@akdeniz.edu.tr (S.B. Çetin), fcebeci@akdeniz.edu.tr (F. Cebeci), oktayeray@akdeniz.edu.tr (O. Eray), mcoskun@akdeniz.edu.tr
(M. Coşkun), meralgozkaya@akdeniz.edu.tr (M. Gözkaya).

https://doi.org/10.1016/j.ienj.2021.101069
Received 20 June 2020; Received in revised form 28 July 2021; Accepted 5 August 2021
Available online 28 September 2021
1755-599X/© 2021 Elsevier Ltd. All rights reserved.
S.B. Çetin et al.
decisions and triage times for every patient. It is of crucial importance to
develop a standard method to evaluate the quality of nurse triage de­
cisions with continuous data in the international domain [13]. In our
study, a computer-based method was developed to meet the needs in this
area. For this purpose, a method that can make continuous and objective
assessments of the accuracy and duration of triage decisions through
Structured Query Language (SQL) scripts using the Hospital Information
Management System (HIMS) database with real patient outputs was
developed, and an example of its application is provided.
1.1. Problem
Technology and computers have become indispensable elements of
health care. These technologies are used by nurses to make healthcare
services safer, more effective, efficient, and patient-centered [14].
Furthermore, the use of computerized systems and technology is rec­
ommended to ensure that nurse triage decisions are accurate and reli­
able [4].
However, in modern triage systems that are applied internationally
[13], studies on the assessment of triage decision accuracy and triage
times have shown that assessments are carried out using tables or paper-
based observations [9,10]. Paper-based methods are time-consuming
and susceptible to human errors [11]. In addition, continuous supervi­
sion and monitoring is important for improving the quality of nurse
triage performance [2,12].
1.2. Aim
This study aims to develop a method that assesses the quality of nurse
triage decisions in emergency departments and contributes to its
improvement. To achieve this purpose, the following goals were
outlined:
1. To retrieve patient data from HIMS using Microsoft SQL Server
(MSSQL) scripts rather than the “emergency room triage patient manual
registry book” currently in use
2. To assess the accuracy of nurse triage decisions and triage times
automatically through HIMS
Before the study, written approval was obtained from the university
administration for the use of the hospital data archive. Because this is a
quality improvement (QI) study, it is not subject to oversight from the
Institutional Review Board.
2. Methods
2.1. Environment
This study was carried out in the tertiary care university hospital
emergency department, with an average annual admission rate of
105.000 patients and an average daily admission rate of 280 patients
daily. Arrangements for the first and second phases of the study were
carried out over a period of three months (March to May 2019). Sample
implementation data were obtained from June 1 to 15, 2019.
The number of triage nurses working in the triage area of the
emergency department was nineteen. Working in the triage area re­
quires a minimum of one (1) year of experience in the emergency
department and six (6) hours of triage training. In the current system,
nurses use the Australasian Triage Scale (ATS) [15] and the Emergency
Severity Index Version 4 (ESIs) [16] to decide on triage categories. These
scales are displayed on a wall in the triage area so that the triage nurses
can refer to them. The vast majority of patient data in the emergency
department were recorded both electronically in HIMS and manually on
paper. However, because the triage nurses were unable to access the
data recorded in the electronic patient records, they performed their
triage assessments through manual records. Furthermore, triage accu­
racy and duration were not assessed in the current system.
2
International Emergency Nursing 59 (2021) 101069
3. Research team
The study design, accuracy assessment, and SQL Script software were
carried out by the research team, which consisted of emergency nurses,
emergency physicians, informatics specialists, and academic nurses.
3.1. Intervention
The study was performed as a quality improvement study, conducted
and reported in accordance with Standards for Quality Improvement
Reporting Excellence (SQUIRE 2.0) [17]. The intervention was carried
out in two stages. The arrangements of the study were carried out over a
period of three months (March to May 2019). An SQL script was
developed using the HIMS database to assess the accuracy and duration
of the triage decision and to retrieve the manual registry book data
about emergency room triage patients from the automated electronic
system. HIMS is a computerized automation system [18]. HIMS is the
abbreviation of the general name given to a group of software that is
used to process all medical patient data [19]. An SQL script is a struc­
tured query language that performs tasks, such as querying, reporting,
and analyzing data according to specified conditions, by providing ac­
cess to the HIMS database [20]. Due to the written SQL script, a
continuous data flow was achieved.
A comparison of the existing system and the new system is provided
in Table 1.
3.1.1. First stage of the study
A plan was made to remove the triage patient registry of the emer­
gency department, which, in the current system, is kept manually and
leads to loss of time and labor. For this purpose, an electronic record list
was created by writing an SQL Script from the database in order for data
to be automatically received from HIMS. The accuracy of the data
received automatically through the SQL Script was compared with the
that of the data manually retrieved from the emergency department
triage patient registry. Once data accuracy was ensured, the data began
to be automatically received from HIMS. In this way, the ’’emergency
department triage patient registry,’’ where records of all patients
admitted to the emergency department are manually registered, was
removed from use, and thus, unnecessary loss of time and labor was
prevented.
3.1.2. Second stage of the study
This study aimed to develop a method that is capable of making
objective assessments of the accuracy and duration of triage decisions.
The criteria to be evaluated for the accuracy of the triage decision are
resource use and clinical outcome measures. The relevant resources are
those specified in the ESI algorithm [16]. ESI is the only major triage
system that determines the triage decision, taking into account the
projected resource needs [21]. There is no resource definition for pa­
tients in categories 1 and 2 in the ESI algorithm [16]. For this reason,
clinical outcome criteria were used as a basis in assessing the accuracy of
triage decisions for categories 1 and 2. Clinical outcome measures are
the death of the patient in the emergency department, hospitalization in
the intensive care unit or clinic, and death within the first 24 h of hos­
pitalization. Clinical outcome criteria are used to evaluate the validity
and reliability of triage systems and triage performance [21].
The researchers defined how data would be received from the system
through an information processing system and wrote the SQL Script.
3.1.3. Method definition of triage decision accuracy based on resource use
The definition was made using the resources defined in the ESI al­
gorithm (Table 2). The resources in the ESI algorithm are suggested for
determining triage categories 3, 4, and 5. If patients did not require any
resources, they were considered to be category 5. If they required the use
of one resource, they were category 4, and the use of multiple resources
indicated category 3.
S.B. Çetin et al. International Emergency Nursing 59 (2021) 101069

Table 1
Quality improvement study.
Current practice The new practice
Practice Purpose Method Intervention Purpose Method

Triage record Manual recording of To obtain Manual and HIMS recording: Writing a SQL Script for To provide continuous data Automatically
data in the triage data about Manuel Data recording: to being automatic retrieval of flow in order to evaluate the from the HIMS
patient registry nurse approximately 1 min for each data from the HIMS and service quality in emergency
simultaneously with triage patient, and 10 to 15 min for data Removal the manual of nurse triageTo prevent
the HIMS calculation at the end of the shift triage patient registry unnecessary loss of time and
and total 250–300 min (about labour
five hours) per day. In addition,
the data was also recording in
HIMS
Accuracy none none NA Writing a SQL Script for To enable for self-audit of Automatically
Assessment accuracy assessment of Nurse Triage in from the HIMS
of Triage nurse triage decisions implementation science for ESI
Decisions
Evaluation of none none NA Revision in the triage To prevent unnecessary Automatically
triage time operations module, waiting To increase nurse from the HIMS
adding triage end time triage quality
and writing a SQL Script
for calculation

emergency department are completed (Table 3).

Table 2
ESI algorithm resources.
3.2. Practice
Resources Not Resources

• Labs (blood, urine) • History & physical (including pelvic)
• ECG, X-rays • Point-of-care testing
• CT-MRI-ultrasound-angiography
• IV fluids (hydration) • Saline or heplock
• IV or IM or nebulized medications • PO medications
• Tetanus immunization
• Prescription refills
• Specialty consultation • Calling family physician
• Simple procedure = 1 • Simple wound care
(lac repair, foley cath) (dressings, recheck)
• Complex procedure = 2 • Crutches, splints, slings
(conscious sedation)
3.1.4. Method definition of triage decision accuracy based on clinical
outcome criteria
Clinical outcome criteria were used for accuracy assessment in pa­
tients with triage categories 1, 2, and 3. The clinical outcome criteria
included death of the patient in the emergency department, hospitali­
zation in the intensive care unit or clinic, and death in the first 24 h of
hospitalization. The decision was deemed to be correct if patients with
any clinical outcome criteria were assigned by the nurse to triage cate­
gories 1, 2, or 3. If patients with clinical outcome criteria were assigned
to triage categories 4 or 5, the decision was deemed to be erroneous. The
SQL script method developed was designed such that the triage decision
could be considered correct if the categories assigned to the patient by
the triage nurse fall into one of the above situations and incorrect if they
do not.
3.1.5. Automatic calculation of triage time via the method
Rule-based interfaces were designed in the emergency department
triage procedures module in HIMS, and the database structure was
changed accordingly. To calculate triage decision duration, arrange­
ments were made for a new record button and save button on the
emergency triage procedure screen, and the triage time was calculated.
This duration refers to the time period from the moment the triage nurse
starts receiving the first data from the patient (clicking the new record
button) to the moment the triage nurse finishes all the procedures for the
patient (clicking the save button). Triage decision durations were
calculated and recorded in seconds (Table 3).
The assessment report regarding the interventions made, the dura­
tion of triage performed by nurses in the emergency department, and the
triage decision can be obtained as soon as the patient’s procedures in the
Before implementation, meetings were held with the faculty mem­
bers of the department of emergency medicine and triage nurses to re­
view the changes specified in the intervention section. Necessary
adjustments were made according to opinions and suggestions. Daily
emergency visits were made by a researcher (SBÇ) for 3 weeks to help
employees adapt to the changes made in the module. In this process,
both the researcher and the emergency department nurse supervisor
provided support for triage nurses to utilize and make proper entries in
the module, and any problems encountered were resolved. Thus, it was
possible to use an electronic registry list instead of the manual ’’emer­
gency department triage patient registry,’’ which is the first stage of
intervention, and to automatically assess the accuracy and duration of
triage decisions, the second stage of intervention, through HIMS. The
study sample consisted of data via HIMS from 3835 patients aged 18 and
above who presented to the adult emergency department between June
1 and 14, 2019.
3.3. Data analysis
The data were automatically transferred to Excel via HIMS, and an
assessment for missing data was performed by three researchers. The
assessment report developed in the study and showing how the accuracy
of the triage decision is assessed is shown in Table 3. The accuracy of the
triage decision was determined using the data recorded in HIMS.
Descriptive information from nurses regarding triage decisions accord­
ing to the developed method is given in Table 4.
4. Results
The study eliminated the need for manual recording of patient data
by triage nurses and the loss of time and labor in analyzing such data.
The emergency department physicians and triage nurses provided pos­
itive feedback about the removal of the “emergency department triage
patient registry,” which was maintained manually, and the automatic
retrieval of the data from the HIMS (Table 1).
This study shows that the accuracy and duration of nurse triage de­
cisions, which cannot be assessed in the current system, can be inte­
grated into a computerized system using an SQL script and the HIMS
database (Table 1).
Table 3 shows the system report produced by the SQL script written
using the HIMS database. This report provides actual patient data about

3
S.B. Çetin et al. International Emergency Nursing 59 (2021) 101069

Table 4

Assessment
Descriptive data regarding triage decisions made by nurses in the developed

duration and accuracy assessment of

Incorrect
Incorrect
Incorrect

Incorrect
Incorrect
Number of resources used for triage, method (n = 3835).

Correct
Correct
Correct

Correct
Correct
Correct
Triage Triage time Triage Decision Accuracy Number of
decision (sec.) (Mean) Correct n Incorrect n Patients
% %
Duration

1 55.21 12 (85.71) 2 (14.29) 14

(Sec.)

2 87.31 141 166 (54.08) 307

77
76
28
64
89
54
67
76
74
59
82
(45.92)
3 94.34 1136 383 (25.22) 1519
Number of

(74.78)
Resources

4 73.11 643 939 (59.36) 1582

triage

(40.64)
5 61.68 310 103 (24.94) 413

0
3
3
0
3
5
5
0
1
3
3
(75.06)
Hospitalization

triage decisions, source identification according to ESI, clinical out­

Clinical Outcomes

comes, triage decision duration, and the assessment of nurse triage de­
cisions (Table 3). This report, which reflects real patient data obtained
1
0
0
1
0
0
0
0
0
0
0

from a computerized system using an SQL script, is a transformation of

Death

the accuracy and duration of nurse triage decisions from paper-based

and individual evaluation methods to electronic systems. It also allows
0
0
0
0
0
0
0
0
0
0
0

the continuous monitoring, control, and assessment of triage data

(Table 3).
Complex

Table 4 shows the results regarding the triage decisions, triage times,
Int.

and the accuracy of the triage decision retrieved via HIMS through the
0
0
0
0
0
0
2
0
0
0
0

SQL Script, performed as a quality improvement intervention. The

Simple

functionality of the method developed was assessed using 3835 patients’

Int‡‡.

data. The method is also monitorable by the director of nursing in the

Triage ending: Data received after the intervention. (It is given in the relevant field in order not to ruin the table layout).
0
0
1
0
0
0
0
0
0
0
0

emergency department. When the average time allocated for triage was
evaluated, it was found to be 55.21 s for triage category 1, 87.31 s for
Medicines

category 2, 94.34 s for category 3, 73.11 s for category 4, and 61.68 s for
category 5. It was determined that the longest average triage time was
Final assessment report regarding the accuracy of triage decisions made by nurses in the emergency department.

0
0
0
0
0
0
0
0
0
1
1

allocated for category 3. Accordingly, it was observed that the nurses’

triage times were quite brief (Table 4).
Liquids
IV-

0
1
0
0
0
1
0
1
1
0
0

5. Discussion
X-ray
EKG/

Constant monitoring, supervision, intervention, and quality

0
1
0
1
0
0
0
0
1
0
0

improvement studies [2,12] are required to improve the performance of

triage nurses [2]. With this quality improvement study, the triage de­
Examinations

cision accuracy and duration assessments are no longer conducted

individually with paper-based methods, making nurse triage data
Rad.

continuously monitorable, auditable, and evaluable.

0
0
1
0
0
1
1
1
0
0
0

In our study, all records kept manually by the triage nurses and the
‡

assessments of these records were converted to a computerized process.

Examination
ESI-Defined Resources

For this reason, the triage patient manual registry book was abolished by
writing an SQL script and using the HIMS database. This helped triage
Lab.

nurses save a significant amount of time (Table 1). In the literature, it is

††

1
0
0
1
1
1
0
0
1
1
0

recommended to use innovative systems to provide objective criteria for

emergency service workers [13] and to keep all records in the electronic
Cons.

medium rather than using paper-based methods [22,23,24]. Also, in

0
0
0
0
1
0
0
1
0
0
0
†

dense data environments, analyzing data and interpreting the results are
very important for decision makers. Information stored electronically is
decision
nurse’s

useful when processed for a specific purpose [25]. Quick and easy access
Triage

to data prevented loss of labor and time, and the possibility of storing
3
3
3
4
2
3
4
3
3
3
4

data also enabled scientific studies. Considering the daily average

number of patients admitted to the emergency department where the
Nurse

6824

6824
6689

9286

study was conducted, the time and labor saved were crucial for triage
15

15
15
15
15
15

15
ID

nurses. All triage nurses provided positive feedback about this quality
Cons.: Consultation;

improvement study.
Lab.: Laboratory;

Int.: Intervention
18:28:37
19:37:02
09:55:19
10:34:58
10:40:43
11:41:50
12:00:04
12:48:34
13:12:23
15:16:35
16:54:44
* Triage

Rad.: Radiology;
ending

In the second phase of the study, a method was developed that can
DATA ON TRIAGE

continuously and objectively evaluate the accuracy and duration of

triage decisions through SQL scripts using real patient outputs and the
18:27:21
19:36:34
09:54:15
10:33:29
10:39:49
11:40:43
11:58:48
12:47:20
13:11:24
15:15:13
16:53:27
starting

HIMS database. With this method, assessing nurse triage decision ac­
Triage
Table 3

curacy and duration became an automatic procedure in HIMS. Triage

††

‡‡
*
†

4
S.B. Çetin et al.
nurses can see the accuracy of the decisions they have made as soon as
the patients’ procedures are completed in the emergency department.
The method report that was routinely produced following the SQL script,
which was written to assess triage decision accuracy and time, provided
nurses with self-assessment opportunities (Table 3). This situation also
enables self-auditing of nurse triage decisions in implementation and the
opportunity for self-determination. When the literature is reviewed,
retrospective studies in which the accuracy of triage decisions is eval­
uated by healthcare professionals are numerous [2,4,7,26,27]. In the
study performed by Martin et al. (2014), the accuracy of triage decisions
was assessed by specialist triage nurses using triage decision forms and
retrospectively reviewing patient information from electronic health
records one by one [8]. In the same study, it was stated that a data
collection period of more than one year caused the participating nurses
to experience fatigue. Moreover, in this study, the fact that one of the 6
ESI-certified specialist nurses, who assessed triage decision accuracy,
achieved a high score suggested the possibility of bias [8]. In the study
performed by Soontorn et al. (2018), the assessment of triage decision
accuracy was conducted by a specialist nurse who calculated the scores
using the ESI guideline, and the same results were confirmed by an
emergency physician and another specialist nurse [6]. In another
descriptive, cross-sectional study performed with 750 patients, triage
decision accuracy was separately determined by physicians and nurses,
and the results were compared. In this study, the limited number of
experienced nurses who could make assessments in the emergency
department was reported as a limitation [26].
There are also studies in the literature in which the accuracy of triage
decisions is assessed through scenarios [2,5,7]. In the study performed
by Mistry et al. (2018), the standard triage scenarios published by the
Agency for Healthcare Research and Quality (AHRQ) were used [5].
Jordi et al. (2015) performed a triage decision accuracy assessment
using 30 standard case scenarios in the ESI practice guidelines. In this
study, the accuracy of ESI scores and interrater reliability (Krippen­
dorff’s alpha) were measured, and it was reported that there were lim­
itations regarding the assessment process. The fact that all nurses were
not included in the study suggests the possibility that nurses with high
triage performance were included in the study, indicating possible se­
lection bias [7]. In our study, contrary to the studies mentioned in the
literature, the assessment of the accuracy of triage decisions and times
was transformed from paper-based methods into an objectively and
constantly measurable computer-based method, and an example of an
assessment report was given. (Table 3). In studies on the accuracy of
triage decisions, it is seen that the decisions have been made by spe­
cialists. However, this method of evaluation can cause loss of time and
labor. In this study, the accuracy assessment of the triage decisions made
by nurses and the triage times can be determined through HIMS via
written SQL scripts. Thus, triage nurses can see the accuracy of their
decisions without the need to collect or assess data by employees, and
managers can assess the triage performance of the employees. Auto­
matic assessment by the method also eliminated the possibility of bias
caused by individual assessments and prevented loss of time and labor.
The SQL Script makes it possible to assess triage decision accuracy data
on a daily, weekly, or monthly basis, at desired time periods or
seasonally, and in a manner that is specific to nurses’ years of seniority.
This approach also provides the opportunity to see patients’ post-
emergency outcomes (hospitalization and death) (Table 3). In a trial
by Tam, Chung, and Lou (2018), it was reported that continuous
monitoring should be performed to strengthen the usefulness and
implementation of the triage system [2]. In our study, the fact that the
assessment of the accuracy decision can be made by a computer-based
method also provides the opportunity for continuous monitoring and
supervision.
With the quality improvement allowed by the study, triage times can
also be automatically retrieved from the computer (Table 4). The
method is designed in such a way that no additional time or registration
is required for the assessment and analysis of these time periods. No
5
International Emergency Nursing 59 (2021) 101069
paper or charts were used to record the times. In their study, Hamatomo,
Yamase, and Yamase (2016) created a triage chart to determine the
duration of triage recording [9]. Similarly, in the study performed by
Gerdtz and Bucknall (2001), the triage decision duration was deter­
mined by the observation method [10]. This quality improvement study
is an innovative approach, allowing triage nurses to audit themselves. It
also provides an understanding of whether patient triage is completed in
an appropriate amount of time. In other words, this approach ensures
the safety of nurse triage decisions. Integrating this method, which is
described in the present quality improvement study, into international
hospital software programs can enable the acquisition of big data
regarding the accuracy and duration of emergency nurse triage de­
cisions. The objective data provided can also be used as a quality
indicator.
6. Limitations
It should be remembered that electronic entry is dependent on
human factors and honest work ethics in technology and computer-
based systems. The study was carried out at a university hospital. The
method that was developed can be internationally integrated into hos­
pital information management system software, and thus, it can be
generalized. However, this approach may not be put into practice in
hospitals that do not use HIMS and/or do not record the criteria data
assessed for the accuracy of triage decisions in HIMS.
7. Conclusions
This quality improvement study has enabled nurse triage decision
accuracy and duration to be evaluated based on real patient outputs and
a computerized system (HIMS). This innovative approach has made the
accuracy and duration of triage decisions objective, controllable, and
continuously measurable. Thus, loss of labor and time has also been
prevented. Triage nurses can determine the accuracy or inaccuracy of
their decisions as soon as the patients’ procedures are completed in the
emergency department. This is also important for nurses with regard to
obtaining feedback on clinical decision-making and their professional
accountability. This quality improvement study has the potential to be
used internationally. The international use of this method can enable the
acquisition of objective/computer-based big data on the accuracy and
duration of emergency nurse triage. The data regarding the accuracy
and duration of emergency nurse triage decisions can also be used for
performance evaluation. Since the method also makes visible any errors
made by nurses regarding triage categories, it can help determine the
need for training in related fields. Objective data provided by HIMS can
also be used as a quality indicator. It is recommended to evaluate the
effect of the method on improved quality of care. In addition, it is sug­
gested to carry out studies on the development of computer-based de­
cision support systems that will increase the accuracy of nurse triage
decisions.
Author contributions
SB and FC was responsible for the study conception and design. OE,
and MC and MG accessed to data, MC wrote a SQL, SB and FC performed
the data analysis. SB and FC were responsible for the drafting of the
manuscript. FC and OE supervised the study.
Ethical Statement
The written approval was obtained from the University Hospital
Administration for the use of the hospital data archive. Because it is a
Quality Improvement (QI) study, it is not subject to the oversight of the
Institutional Review Board-IRB. This study also meets with “the 18
HIPAA” standards.
S.B. Çetin et al.
Funding Source
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
The authors would like to thank the Akdeniz University Hospital
Managers for the permission and data Access.
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