Emergency department triage performance timing. A regional multicenter descriptive study in Italy.

OBJECTIVES: We explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions. METHODS: This is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system. The sample was made up of 1/3 of nurses working in each ED. Sampling was performed by a stratified proportional randomization (length of service classes: <5 years; 5-10 years; >10 years). Triage nurses were observed during their triage work-shift. RESULTS: In 2014, 120 nurses were observed, during 1114 triage processes. The timings of triage phases were: waiting time to triage, median 2.55 min (IQR 1.28-5.03 min; range 0.1-56.25 min); triage duration, median 2.58 min (IQR 1.36-4.35 min; range 0.07-50 min). 400 interruptions were recorded (35.9%). In 9.9% there were 2 interruptions at least. There were significant differences in the medians of triage duration among the years of nurses' triage experience (P < 0.001). The presence of interruption was significantly associated with the increasing of the time intervals in all the triage phases (P < 0.0001). Finally, we recorded significant differences in all the triage time phases between the EDs. CONCLUSION: We found that the nurses triage time performances are similar to other triage systems in the world.

Communication during handover in the pre-hospital/hospital interface in Italy: from evaluation to implementation of multidisciplinary training through high-fidelity simulation.

Communication failures in the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. This interface has not adequately been studied in Italy. In this study, we: (1) evaluated the communication of pre-hospital and hospital providers during handover through the analysis of simulation sessions; (2) identified the critical information that should be routinely communicated during handover with a survey administered to emergency triage nurses; (3) measured communication within this interface through the adaptation of an existing tool from a multidisciplinary focus group; (4) validated the adapted tool with the inter-rater agreement of physicians who reviewed video recordings from multidisciplinary simulations sessions; and (5) developed a handover training for pre-hospital providers and evaluated the communication improvement between pre- and post-training. In our simulations we found an absence of standardization of the handover communication process, marked variability in information communicated, and a lack of formal transfer of responsibility of patient care. We adapted existing handover communication tools for local use and developed a checklist for the evaluation of handover communication that had good inter-rater reliability. Lectures coupled with high-fidelity simulation exercises on handover did result in a statistically significant improvement in handover communication.