Accuracy of Emergency Department Nurse Triage Level Designation and ...

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Nursing Dissertations (PhD)

School of Nursing

Spring 2-14-2012

Accuracy of Emergency Department Nurse Triage Level Designation and Delay in Care of Patients with Symptoms Suggestive of Acute Myocardial Infarction

Susan S. Sammons

Georgia State University

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Sammons, Susan S., "Accuracy of Emergency Department Nurse Triage Level Designation and Delay in Care of Patients with Symptoms Suggestive of Acute Myocardial Infarction." Dissertation, Georgia State University, 2012.

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ACCEPTANCE

This dissertation, ACCURACY OF EMERGENCY DEPARTMENT NURSE TRIAGE LEVEL DESIGNATION AND DELAY IN CARE OF PATIENTS WITH SYMPTOMS SUGGESTIVE OF ACUTE MYOCARDIAL INFARCTION by Susan Sanders Sammons was prepared under the direction of the candidate's dissertation committee. It is accepted by the committee members in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing by the Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University.

____________________________________ Cecelia M. G. Grindel, PhD, RN, FAAN Committee Chairperson

____________________________________ Ptlene Minick, PhD, RN Committee Member

____________________________________ Holli DeVon, PhD, RN Committee Member

____________________________________ Date

This dissertation meets the format and style requirements established by Byrdine F. Lewis School of Nursing and Health Professions. It is acceptable for binding, for placement in the University Library and Archives, and for reproduction and distribution to the scholarly and lay community by University Microfilms International.

_________________________________ Joan Cranford, EdD, RN Assistant Dean for Nursing Byrdine F. Lewis School of Nursing and Health Professions

_________________________________ Cecelia M. G. Grindel, PhD, RN, FAAN Professor & Interim Dean Byrdine F. Lewis School of Nursing and Health Profession

AUTHOR'S STATEMENT In presenting this dissertation as a partial fulfillment of the requirements for an advanced degree from Georgia State University, I agree that the Library of the University shall make it available for inspection and circulation in accordance with its regulations governing materials of this type. I agree that permission to quote from, to copy from, or to publish this dissertation may be granted by the author or, in his/her absence, by the professor under whose direction it was written, or in his/her absence, by the Assistant Dean for Nursing, Byrdine F. Lewis School of Nursing and Health Professions. Such quoting, copying, or publishing must be solely for scholarly purposes and will not involve potential financial gain. It is understood that any copying from or publishing of this dissertation which involves potential financial gain will not be allowed without written permission from the author.

____________________________________ Susan Sanders Sammons

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NOTICE TO BORROWERS

All dissertations deposited in the Georgia State University Library must be used in accordance with the stipulations prescribed by the author in the preceding statement.

The author of this dissertation is:

Susan Sanders Sammons

The director of this dissertation is:

Dr. Cecelia M. G. Grindel Professor Byrdine F. Lewis School of Nursing and Health Profession Georgia State University P.O. Box 3995 Atlanta, GA 30302-4019

Users of this dissertation not regularly enrolled as students at Georgia State University are required to attest acceptance of the preceding stipulations by signing below. Libraries borrowing this dissertation for the use of their patrons are required to see that each user records here the information requested.

NAME OF USER ADDRESS

DATE

TYPE OF USE (EXAMINATION ONLY OR COPYING)

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ADDRESS:

EDUCATION: PhD MSN BSN ADN

VITA

Susan S. Sammons

1417 Dale Drive Savannah, GA 31406

2012 2005 2005 1984

Georgia State University Atlanta, Georgia Armstrong Atlantic State University Savannah, Georgia Armstrong Atlantic State University Savannah, Georgia Florida State College Jacksonville, Florida

PROFESSIONAL EXPERIENCE: 2011 - Present 2007 ? 2011 2001 ? 2011

1996 ? 2001 1994 ? 1996 1989 ? 1994 1986 ? 1989 1985 ? 1986 1984 ? 1985

Emergency Services Clinical Nurse Specialist, St. Joseph's Candler Health System Assistant Professor, Armstrong Atlantic State University Staff Nurse, Senior Nurse, Clinical Nurse Specialist, Emergency Department, Memorial University Medical Center Staff Nurse, Compliance Manager, Hospice Savannah Staff Nurse, Oncology Unit, Candler General Hospital Charge Nurse, Medical/Surgical Unit, Memorial University Medical Center Director of Nursing, Helping Hands Home Care Staff Nurse, Candler Home Health Services Staff Nurse, Oncology Unit, Memorial University Medical Center

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PROFESSIONAL ORGANIZATIONS AND CERTIFICATIONS:

2007 ? Present

Certification in Emergency Nursing (CEN)

2002 ? Present

Emergency Nurses Association (ENA)

2012 ? Present

President, ENA Coastal Empire Chapter

2001 - Present

Sigma Theta Tau International, Rho Psi Chapter

2005 ? Present

Georgia Nurses Association (GNA)

HONORS: 2010

2011

Kaiser-Permanente Evidence-Based Practice Research Award Armstrong Atlantic State University, Brockmeier Faculty Award Nominee

ABSTRACT ACCURACY OF EMERGENCY DEPARTMENT REGISTERED NURSE TRIAGE LEVEL DESIGNATION AND DELAY IN CARE OF PATIENTS WITH SYMPTOMS

SUGGESTIVE OF ACUTE MYOCARDIAL INFARCTION by

SUSAN S. SAMMONS More than 6 million people present to emergency departments (EDs) across the US annually with chief complaints of chest pain or other symptoms suggestive of acute myocardial infarction (AMI). Of the million who are diagnosed with AMI, 350,000 die during the acute phase. Accurate triage in the ED can reduce mortality and morbidity, yet accuracy rates are low and delays in patient care are high. The purpose of this study was to explore the relationship between (a) patient characteristics, registered nurse (RN) characteristics, symptom presentation, and accuracy of ED RN triage level designations and (b) delay of care of patients with symptoms suggestive of AMI. Constructs from Donabedian's Structure-Process-Outcome model were used to guide this study. Descriptive correlational analyses were performed using retrospective triage data from electronic medical records. The sample of 286 patients with symptoms suggestive of AMI comprised primarily Caucasian, married, non-smokers, of mean age of 61 with no prior history of heart disease. The sample of triage nurses primarily comprised Caucasian females of mean age of 45 years with an associate's degree in nursing and 11 years' experience in the ED.

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RNs in the study had an accuracy rate of 54% in triage of patients with symptoms suggestive of AMI. The older RN was more accurate in triage level designation. Accuracy in triage level designations was significantly related to patient race/ethnicity. Logistic regression results suggested that accuracy of triage level designation was twice as likely (OR 2.07) to be accurate when the patient was non-Caucasian. The patient with chest pain reported at triage was also twice as likely (OR 2.55) to have an accurate triage than the patient with no chest pain reported at triage. Electrocardiogram (ECG) delay was significantly greater in the patient without chest pain and when the RN had more experience in ED nursing. Triage delay was significantly related to patient gender and race/ethnicity, with female patients and non-Caucasian patients experiencing greater delay. An increase in RN years of experience predicted greater delay in triage. Further studies are necessary to understand decisions at triage, expedite care, improve outcomes, and decrease deaths from AMI.

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