Knowledge of Health Care Professionals of the Emergency Department of the Hospital of N. Attica in the Emergency Severity Index Triage System

Introduction: Patient attendance in the Emergency Department (ED) often exceeds the human and material resources available to provide health services. There are many standardized models of Hospital triage. One of the most reliable and widespread triage system, worldwide and in Greece, is the Emergency Severity Index (ESI). Aim: The aim of this study was to investigate the knowledge of healthcare professionals in the triage of patients in ED according to the international ESI classification system. Material and Method: This was a cross-sectional study involving 16 healthcare professionals working in the ED of a major hospital in county of Attica. Sixty standardize screening scenarios from the ESI manual were used. All participants were trained at ESI at the first time that triage system was applicated to the hospital. In each scenario, the rate and percentage of the correct answers, the undertriage and the overtriage were calculated separately. The study was conducted between November and December 2017. The statistical analysis of the data was done with the SPSS Statistics for Windows, Version 17.0 statistic package. Chicago: SPSS Inc. Results: Totally, 8 nurses and 8 doctors participated in the study, answering to 60 scenarios, a total of 960 cases. The average percentage of correct responses to all scenarios was 63.1% (95% CI 55.2–68.4%). The remaining scenarios were either overtriaged (13.3%) or undertriaged (23.6%). The accuracy of the scores was significantly higher in adult than pediatric scenarios (64.4% vs 56.8%, p<0.001) and in non-trauma than trauma scenarios (63.2% vs. 62.5%, p<0.001). Participants responded more accuracy to low triage acuity scenarios (ESI 5) (81.6, 95% CI: 61.1–78.7%) and high triage acuity scenarios (ESI 1) (76.6, 95% CI: 67.3–85.8%), followed by ESI 4 scenarios (63.1, 95% CI: 55.3–72.8%), ESI 3 scenarios (54.3, 95% CI: 40.7–62.4%) and ESI 2 scenarios (51.8, 95% CI: 39.6–60.2%). Undertriage was more frequent than overtriage (23.6% vs 13.3%). No correlation was found between the total years of work and the undertriage (r=0.289, p=0.338) and overtriage (r=0.524, p=0.066) and among the total years of work in ED and both undertriage (r=0.340, p=0.256) and overtriage (r=0.249, p=0.411). Conclusions: The knowledge of healthcare professionals in the ESI triage system is at moderate levels but comparable to the international literature. It is proposed to modify the undergraduate curriculum of healthcare professionals, doctors and nurses, in order to include a triage course in the context of emergency.