The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

Songül Bişkin Çetin; Fatma Cebeci; Oktay Eray

doi:10.1016/j.ienj.2023.101341

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

Int Emerg Nurs. 2023 Sep:70:101341. doi: 10.1016/j.ienj.2023.101341. Epub 2023 Sep 12.

Authors

Songül Bişkin Çetin¹, Fatma Cebeci², Oktay Eray³

Affiliations

¹ Akdeniz University, Faculty of Nursing, Department of Surgical Nursing, Antalya, Turkey. Electronic address: songulbiskin@akdeniz.edu.tr.
² Akdeniz University, Faculty of Nursing, Department of Surgical Nursing, Antalya, Turkey. Electronic address: fcebeci@akdeniz.edu.tr.
³ Akdeniz University Hospital, Faculty of Medicine, Departments of Emergency Medicine, Antalya, Turkey. Electronic address: oeray@bandirma.edu.tr.

PMID: 37708790
DOI: 10.1016/j.ienj.2023.101341

Abstract

Background: Deciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience.

Purpose: This study was conducted to evaluate the effect of a "computer-based emergency department triage decision support system (DSS)," which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data.

Methods: Single-group, pretest-posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied.

Results: The effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest.

Conclusions: The DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

Keywords: Clinical decision support system; Emergency service; Nursing; Triage.