Interruptions contribute to catastrophic errors in healthcare. This is particularly true in the interruption-laden emergency department (ED). Unlike interruptions that occur at the bed side, triage interruptions are especially impactful because triage is the beginning of treatment trajectory for these patients. However, current triage training does not provide specific training on interruption management. In this proposal we will conduct an Online Modified Delphi (OMD) group of 12 triage and operational experts to identify the competencies required to effectively mitigate the impact of triage interruptions. Once competencies are established by the ODM group, the research team along with the ED nurse educator and director will develop an educational intervention and simulation scenarios to mimic common triage interruption experiences. Twenty ED nurses nave to triage and scheduled for triage training will be randomly assigned to either a control (routine triage training only) or experimental group (educational intervention + routine triage training). Following orientation, all participants will complete the simulation scenarios and observed in triage. Triage duration and accuracy will be recorded and the participant's success at managing interruptions will be scored by a blinded reviewer. Participants will evaluate the experience and self-report their sense of control and confidence during triage. Although the results will be used to determine an effect size for a larger randomized control study, the greatest expectation is to have a prototype educational intervention that can be used in a variety of settings to train providers in multiple healthcare settings to use effective strategies to manage interruptions.
In an effort to mitigate the negative impact of triage interruptions in the Emergency Department, we plan to develop an educational intervention to teach triage nurses successful strategies to manage interruptions. An Online Modified Delphi group of triage experts will identify the core competencies of triage interruption management which will then be developed into an educational session complete with simulated scenarios where interruptions occur. Once developed, an experimental design will be used to test the intervention for 20 emergency nurses to determine differences in triage accuracy and duration as well as the nurses' stress, confidence level and their ability to manage triage interruptions.
