Advisor(s)

Allison Jones

Committee Member(s)

Adelais Markaki
Lisa Wolf
Melanie Hallman
Michelle Brown
Peng Li

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Nursing

Department

Nursing

Abstract

Triage is a critical function of emergency nursing practice, directly influencing patient safety, flow, and outcomes in the emergency department (ED). Despite widespread use of standardized triage training and resources, triage accuracy among ED nurses remains suboptimal. The purpose of this three-manuscript dissertation was to examine factors associated with triage accuracy in the ED setting. Manuscript One was an integrative literature review of 14 studies published between 2011 and 2021, with reported triage accuracy rates ranging from 59.3% to 82%. Primary factors associated with triage accuracy were: nurse-specific, patient, and work environment factors. Manuscript Two reported a retrospective study of 100 ED patients comparing the documented acuity level with the acuity based on extracted patient information and the Emergency Severity Index Handbook. Triage accuracy levels assigned by the nurses achieved 67%; 25% of cases were under-triaged, and 8% were over-triaged. Accuracy was higher for female, non-trauma, and night-shift cases, and greatest among ambulance arrivals. Findings highlight the multifactorial nature of triage accuracy, influenced by both patient characteristics and work conditions in EDs. Manuscript Three presented findings from an electronic, cross-sectional survey of 132 ED nurses that examined nurse-specific factors associated with triage accuracy. Triage accuracy across three clinical vignettes was 62.6%. In multiple regression, factors associated with increased likelihood of triage accuracy were: level of education (Bachelor- vs associate-prepared nurses (adjusted odds ratio [AOR] = 1.98-2.26, p < .0140)); and completion of specialized trainings or certifications, such as Emergency Nurse Practitioner (AOR = 1.90, p = .0270), Trauma Nursing Core Course (AOR = 2.20, p = .0006), and refresher triage training (AOR = 3.07, p < .0001). Nurses with multiple specialized trainings achieved the highest performance (AOR up to 6.56, p < .0001). Years of ED nursing experience increased accuracy by 9-20 percent (p < .0033). Findings align with existing literature and introduce evidence that nurse-specific factors are associated with higher triage accuracy. Collectively, these support competency-based education, structured refresher programs, and standardized training requirements to enhance triage accuracy. Future research should serve to identify best practices for initial triage training and skill retention to promote optimal patient outcomes.

Keywords

Emergency Nursing;Experience;Nurse Education;Refresher Training;Specialized Training;Triage Accuracy

ProQuest Publication Number

32285951

ISBN

9798273382374

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