Triage narratives – exploring a widely collected but dramatically underexplored source of emergency department data

• Author / Creator

  Picard, Christopher

• Emergency departments (ED) around the globe rely on triage to sort which patients can wait safely for care when the demand for service outstrips the resources available. The triage process is typically performed by experienced emergency nurses and can be the earliest documented assessment for patients receiving hospital-based care. Because the ED is the most common entry point for patients, triage documentation, specifically triage narratives, are nearly ubiquitous for hospitalized patients. The data collected during triage can be structured (information such as age and sex) or unstructured (in the case of free-text narratives). In Canada, ED data are reported as a national dataset, much of the reported data is collected at triage, but little of the national dataset reflects nurses own work and the triage narratives are not included. The goal of this paper-based thesis is threefold: first, to describe the role of ED nurse in data collection; second, to provide a scoping review protocol for examining triage narratives; and, to describe how triage narratives have been used in the academic literature.
  The first portion of this thesis reviews the systems used in Canada for ED data collection. This chapter highlights how little nursing data is collected and proposes that national organizations need to demonstrate that there is utility in collecting these triage data. It calls on the National Emergency Nurses Association to take concrete first steps to press for ED nurse data to be included in national ED data registries.
  In the second phase of this thesis, I provide an outline and rationale for how to review one specific component of triage nurse data: the unstructured narrative. The narratives, which have been included in other reviews of clinical documentation have show promise for a number of uses, but they have not been reviewed as a unique form of documentation. The scoping review protocol outlined each step that should be taken in conducting a review on the topic to ensure that subsequent reviews are rigorous. It offers a template upon which future reviews can use and improve upon.
  The third component of this thesis are the results of the scoping review, which mapped the literature around triage narratives and described the narrative structure and its uses. In this review we screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. 96 studies from this initial sample examined triage nurse narratives. Theses studies represent over 12 million ED visits and 2438 EDs. We grouped reviewed studies as using narratives for one of the following: case identification, as input variables for predictive modeling, and for quality improvement. Despite the breadth of research there was not much data on the structure of narratives: 27 studies reported the keywords that they used to search triage narratives, 7 offered descriptions of the narratives (typically the number of words used), but only one study described the narratives in any detail. Unfortunately, none of the studies that described the structure of narratives also described the nurses who wrote them – of the 9 studies that included a sample size for the nurses, none described the narratives. Additionally, fewer than 10% of studies (n=8) used reporting guidelines.
  This thesis demonstrates that there are myriad uses for triage narratives, and potential for additional synthesis of triage narrative studies. It also details how there is a striking paucity of research describing the structure of narratives or the nurses who generate them. There is a clear opportunity to describe triage narratives. In doing there is an opportunity to highlight the importance of this data type and to strengthen the validity of studies that have used them to conduct research. Canadian EDs are well positioned to do support this work given the national triage system and existing data collection structures.

• Subjects / Keywords

  • nursing
  • artificial intelligence
  • machine learning
  • triage
  • review

• Graduation date

  Spring 2023

• Type of Item

  Thesis

• Degree

  Master of Nursing

• DOI

  https://doi.org/10.7939/r3-fxye-tb78

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.