The Emergency Triage Education Kit: Improving paediatric triage

Abstract

Objectives: The Emergency Triage Education Kit (ETEK) was published in 2007. To date, the impact of ETEK has not been measured. The purpose of this study was to measure the effectiveness of ETEK on paediatric triage. Method: A retrospective chart audit was undertaken in a tertiary paediatric hospital. Its’ aim was to review the completeness of documentation recorded at the point of triage after a standardised documentation framework was introduced and to measure inter-rater agreement. Primary assessment and physiological discriminators documented at the point of triage were compared with those from the paediatric physiological discriminator table (PPDT) within ETEK. Using an audit tool developed by the researchers, a parallel decision-making pathway was used to ascertain whether the original ATS score could be substantiated by the PPDT. Improvement in documentation of the primary assessment and inter-rater agreement was measured over time. Results: 600 triage records were selected; 200 each from 2007, 2008 and 2010. Triage documentation that did not support parallel decision-making decreased significantly according to the year of presentation (2007; 112 (56%), 2008; 106 (53%), 2010; 13 (7%), P < 0.001). When parallel decision-making was facilitated by an improvement in triage documentation, there was improvement in matched triage scores (2007; 54%, 2008; 69%, 2010; 72%, P = 0.01). Conclusion: The introduction of ETEK has had a significant impact in this ED, particularly when combined with education sessions. The use of the PPDT as a framework to guide documentation and triage language facilitated parallel decision-making and auditing, and led to an improvement in inter-rater agreement when applied to children.