ER TRIAGE PROTOCOLS: Do Little to Standardize Care
The use of standard protocols in emergency rooms apparently does little to even out care, according to a recent study that found widely divergent advice given to mock patients by triage nurses. The University of New Mexico-Albuquerque study presented 15 emergency cases to 12 pediatric ER nurses, who "assigned patients' complaints to severity categories" using nine different protocols. The researchers found that "nurses did not reliably choose the same protocol in a given case and did not reach the same triage endpoint even when they followed the same protocol."
Follow-up interviews showed 58% of participating nurses said they were frustrated by the narrow confines of the protocols, and that 42% of them "admitted to stepping out of those confines when they believed that optimal patient care mandated that they do so." The authors comment that this finding is "particularly notable," as the play-acted interactions did not put real patients at risk but real-life scenarios would likely find more nurses abandoning the protocols. The researchers concluded "the use of protocols cannot be assumed to result in standardized patient management," and the use of protocols "in triage must be studied more rigorously before they can be safely disseminated for general use" (Wachtar et al., Annals of Emergency Medicine, 4/99 issue).