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Nurses in pediatric ER study follow
wide variations in protocol Posted 4-12-99 A recent study raises questions about the use of standardized protocols in telephone triage. The study, performed by the department of emergency medicine at the University of New Mexico in Albuquerque, and published in this month’s Annals of Emergency Medicine, was conducted to determine if standardized pediatric ER telephone protocols brought consistent triage results when used by different operators. In the study, a mock parent presented 15 respiratory cases to 12 pediatric emergency nurses who were instructed to follow the protocols in making a decision about patient care. The study found wide variation in the choice of protocols used by the nurses and in the final disposition of the "patients." In only one of the 15 cases did all 12 nurses use the same treatment protocol. Even in that one case, however, the nurses arrived at four different final dispositions. Fifty-eight percent of the nurses said they felt confined by the protocols, and 42 percent said they had knowingly deviated from the protocols at least once during the interviews. Study author Judith Brillman, MD, associate professor of emergency medicine and residency director for emergency medicine at the University of New Mexico School of Medicine, said she was prompted to do the study because of her own experiences with pediatric patients who were inappropriately triaged. "It made me wonder if these [protocols] were not as good as people thought they were," she said. "I find it ironic that we spend millions evaluating drugs and procedures, but there has been little evaluation of these things that limit access to care." Valerie Grossman, RN, a certified emergency nurse and national chairperson for the telephone triage special interest group of the Emergency Nurses Association, shares Brillman’s concern about telephone triage, but feels it is a valuable and appropriate service when done correctly. "I know there is a wide diversity in the training, and monitoring, and follow-up of triage systems," she said. "However, I was somewhat disappointed that the study was not conducted on an existing program, where nurses have had thorough and extensive training." "The nurses in our triage system had a week of classroom instruction, followed by three weeks working with a preceptor. I feel protected by protocols," Grossman said. "When you’re on your 30th patient for the shift, it would be easy to skip something; the protocols don’t allow you to do that—you have to follow them line by line." Related Sites |