Evaluation of a multifaceted intervention on documentation of vital signs at triage: a before-and-after study.

Background: Triage systems provide a centralised safety mechanism where all patients are assessed for clinical urgency at point of entry to the ED.

Objective: The present study aims to evaluate the effect of a multifaceted intervention on triage documentation rates and guideline adherence.

Methods: A before-and-after design was used. The intervention involved restructuring the computerised interface, regular audit and feedback and education sessions. The setting was one adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. Participants were triage nurses. Data were collected at five time points for a consecutive sample of one month of presentations.

Results: Over a 15 month period, we sampled 35.8% (24,862/69,395) episodes of triage performed by 122 nurses. Documentation rates for all vital signs progressively increased from baseline. There were significant increases in the proportion of episodes of triage where any vital sign was documented (32.2% vs 82.6%), and where pair and triplet combinations of vital signs were recorded in the triage field (heart rate and respiratory rate: 17.9% vs 64.6%; heart rate, respiratory rate and temperature: 7.0% vs 30.4%). No significant change in guideline adherence was observed after the intervention.

Conclusion: Progressive sustained improvements in vital sign documentation were observed over the study period; however, no such increases were noted in guideline adherence. To facilitate evaluation of guideline adherence, we recommend specific vital sign parameters be included in the Australasian Triage Scale Guideline for all levels of urgency.