Search Results (52)

Objective: The impact of a febrile neutropenia (FN) emergency department (ED) triage screening tool and protocol on time to antibiotic administration (TTA) and patient outcomes was evaluated. Methods: This was a retrospective, quasi-experimental study of adult FN patients admitted through the ED from April 2014 to April 2017. In March 2016 a triage screening tool and protocol were implemented. In patients who screened positive, nursing initiated a protocol that included laboratory diagnostics and a pharmacy consult for empiric antibiotics prior to evaluation by a provider. Patients were evaluated pre- and post-protocol for TTA, 30-day mortality, ED length of stay (LOS), and hospital LOS. Results: A total of 130 patients were included in the study, 77 pre-protocol and 53 post-protocol. Median TTA was longer in the pre-protocol group at 174 min (interquartile range [IQR] 105–224) vs. 109 min (IQR 71–214) post-protocol, p = 0.04. Thirty-day mortality was greater at 18.8% pre-protocol vs. 7.5% post-protocol, p = 0.12. There was no difference in hospital LOS. Pre-protocol patients compared to post-protocol patients who had a pharmacy consult demonstrated a further reduction in TTA (174 min [IQR 105–224] vs. 87.5 min [IQR 61.5–135], p < 0.01) and a reduced mortality (18% vs. 0%, p = 0.04). Conclusions: To our knowledge, this is the first report of a protocol for febrile neutropenia that allows pharmacists to order antibiotics based on a nurse triage assessment. Evaluation of the protocol demonstrated a significant reduction in TTA and trend toward improved mortality. Full article

Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely clinical decision-making but also for timely diagnosis and promoting appropriate antibiotic use. Methods: This cross-sectional study analyzed 475 adult patients with suspected sepsis who presented to the emergency department of a Thai community hospital, using retrospective data from January 2021 to December 2022. Six screening tools were evaluated: Systemic Inflammatory Response Syndrome (SIRS), Quick Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), National Early Warning Score version 2 (NEWS2), and Search Out Severity (SOS). Diagnostic accuracy was assessed using International Classification of Diseases, Tenth Revision (ICD-10) codes as the reference standard. Performance metrics included sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (AUROC) curve, all reported with 95% confidence intervals. Results: SIRS had the highest sensitivity (84%), while qSOFA demonstrated the highest specificity (91%). NEWS2, NEWS, and MEWS showed moderate and balanced diagnostic accuracy. SOS also demonstrated moderate accuracy. Conclusions: A two-step screening approach—using SIRS for initial triage followed by NEWS2 for confirmation—is recommended. This strategy enhances nurse-led screening and optimizes limited resources in emergency care. Early sepsis detection through accurate screening tools constitutes a feasible public health intervention to support appropriate antibiotic use and mitigate antimicrobial resistance, especially in resource-limited community hospital settings. Full article

Objectives: While pre-screening triage (PST) enhances healthcare efficiency in emergency and pediatric settings, its application in dental healthcare remains undervalued. This novel study implemented PST in dental services, identifying determinants of physician–patient dissatisfaction to optimize triage systems and promote dental health outcomes. Methods: A cross-sectional survey (July–September 2024) recruited 113 physicians and 206 patients via convenience sampling. Dissatisfaction levels were quantified using validated questionnaires and analyzed through t-tests, ANOVA, and regression models. Results: In total, 37.17% of physicians with prior PST experience demonstrated significantly higher dissatisfaction scores (37.67 ± 9.08 vs. 32.51 ± 10.08, p = 0.006). Multivariate analysis revealed that experienced physicians rated PST services 5.63 points higher than less experienced counterparts (95% CI: 0.75–10.51). Dental patients expressed dissatisfaction with nurse attitudes (β = 1.04, 95% CI: 0.07–2.01) and triage process inefficiencies. Conclusions: Key dissatisfaction drivers include a lack of physician PST exposure and nurse–patient interaction quality in dental settings. These findings advocate for the development of a specialized triage system to enhance clinical workflow efficiency and service effectiveness in dental healthcare. Full article

Background: Disasters pose significant challenges to public health by disrupting essential services, especially during mass gatherings such as the Hajj pilgrimage. These complex events demand swifts coordinated action from healthcare professionals. However, many remain insufficiently equipped for large-scale emergencies due to gaps in triage training, disaster knowledge, and established response protocols—issues that are particularly critical in high-risk settings. Aim: This systematic literature review aims to explore the clinical insights of registered nurses and other healthcare professionals in disaster preparedness and response during the Hajj pilgrimage in Saudi Arabia. Methods: A systematic literature review was conducted following PRISMA guidelines. A comprehensive database search was performed across CINAHL, Scopus, Medline, Embase, and APA PsycINFO, focusing on studies published between 2012 and 2025. Eligible studies addressed disaster nursing education, preparedness, and response. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. Results: Twenty-three studies met the inclusion criteria. Three main themes emerged: disaster preparedness, experiences and challenges in disaster response, and education and training. The review revealed lack in nurses’ readiness, policy awareness, and real-world disaster experience. Training and curriculum improvements are essential to enhance disaster response capabilities. Conclusions: This review highlights the urgent need for standardized disaster nursing curricula to enhance preparedness and response competencies. Incorporating structured disaster training into nursing education will strengthen healthcare system resilience. Future research should adopt qualitative methods to capture healthcare professionals lived experiences during the Hajj. Including diverse participants and focusing on the unique cultural context can enhance disaster preparedness and response strategies. Full article

Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: pre-implementation (April 2023–July 2023) vs. post-implementation (August 2023–July 2024), and temporally matched cohorts (April–July 2023 vs. April–July 2024). We assessed clinical outcomes (sepsis-associated mortality, hospital length of stay, or HLOS), and resource utilization (antibiotic use, blood cultures). Results: Post-implementation, sepsis-associated mortality dropped from 10.9% to 6.6% in the temporally matched group (p < 0.001). There was also a 0.76-day reduction in mean HLOS among sepsis DRG patients (p < 0.05). Blood culture utilization fell from 50.8% to 45.7%, driven by reductions in blood culture utilization among patients receiving a Band 1 IntelliSep score. Conclusions: The FMOLHS experience demonstrated significant benefits to patient outcomes and resource utilization after implementing a sepsis QI initiative including protocolized and standardized ED workflows via a nurse-driven triage system with sepsis testing for the early risk stratification of patients who present to the ED with signs and symptoms of infection. Full article

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available. Full article

Background: Nursing and midwifery expertise exceeds the realms of clinical and biomedical knowledge. With the healthcare system transforming towards the Fourth Industrial Revolution (4IR), midwives are expected to broaden their knowledge and skills to provide quality care through the use of digital health technologies. However, there is a paucity of studies that look at the perceptions of midwives towards these digital health technologies. Objective: Hence, in this case, the authors sought to investigate the perceptions of the midwives towards the adoption of digitalized triage system in their maternity units, prior to designing and implementing the digitalized system. This was undertaken to avoid imposing a huge change upon the midwives which will consequently affect the widespread implementation of the proposed system. Methods: A sequential exploratory research design within a pragmatic paradigm underpinned this study to gain a comprehensive understanding of the midwives’ perceptions on the adoption of a digitalized triage system in the maternity units. The qualitative phase embraced purposive sampling to select participants, and data saturation was reached at 20th midwife. Meanwhile, the quantitative phase embraced a stratified sampling technique and the sample size was 155. The mixed methodological analysis was conducted using a case-comparison analytical strategy. Results: The study revealed that the midwives perceived that the adoption of a digitalized triage system would improve their skills and enhance positive health outcomes for the patients. However, they were concerned with implementation challenges such as the availability of resources and network connectivity. Conclusions: The findings suggested that midwives in this modern era are accepting of digital health interventions as they perceive them to be useful. However, the digital health intervention was also perceived to possibly be affected by external factors such as digital illiteracy, lack of resources and internet connectivity failures. Therefore, there is a need for the development of guidelines and a conceptual framework dedicated to facilitating the widespread implementation of digital triaging in maternity units in South Africa. Full article

Background: Trauma is a leading cause of morbidity and mortality worldwide, often resulting in devastating physical, psychological, and social consequences. Nurses play an essential role in stabilizing patients, managing acute care, and ensuring continuity of treatment. Given the complexity of trauma care, continuous specialized training in nursing is crucial to enhance the quality of interventions and improve patient outcomes. Objective: We aimed to map and analyze nursing interventions in approaching trauma victims. Methods: This scoping review followed the methodology proposed by the Joanna Briggs Institute. The literature search was conducted in databases available on the EBSCOhost platform and in PubMed. The research question guiding this review was as follows: what nursing interventions are used to approach trauma victims? Results: Thus, 1454 articles were identified (348 from ESBOhost and 1106 from PubMed), with 13 meeting the inclusion criteria. The findings were categorized into six key areas: (1) Triage, (2) Initial Approach, (3) Secondary Approach, (4) Professional Training, (5) Interdisciplinary Collaboration, and (6) Care Maintenance. Conclusions: Trauma victims require immediate and complex care. Nurses are pivotal throughout all clinical phases, delivering physical and psychological support, collaborating with multidisciplinary teams, and advancing professional training and community education. Full article

Background/Objectives: The COVID-19 pandemic overwhelmed many health care facilities with patients, leading to an increased risk of potential transmission. Though the disease process was identical, the triaging system was unique at different sites, without a unified system for emergency department triaging globally. Proper implementation of pre-screening and triaging is of paramount importance in tertiary care settings to prevent nosocomial spread of infection. Methods: Each country has its own triage guidelines and Infection, Prevention, and Control policies developed by its health ministry and may face significant challenges in implementing them. Triage guidelines followed by two tertiary care hospitals in Detroit, United States of America and Manipal, India are compared during the early phases of the COVID-19 pandemic. Results: This paper offers a unique perspective of the challenges experienced with the hospital triage practices and provides solutions to address them. The future trajectory of COVID-19 epidemiology in both countries will be determined by the adherence to best practices in Infection Prevention and Control and triage protocols. The healthcare facility triage algorithm is constantly evolving in both settings as new evidence is being added to hospital epidemiology and infection prevention practices. Conclusions: Training healthcare workers on new triage protocols is required. It is critical for infectious disease doctors, clinical microbiologists, hospital epidemiologists, and Infection Prevention and Control (IPC) staff to collaborate with clinicians, nurses, and other ancillary staff in order to successfully implement the triage protocols. Developing and modifying guidelines for cleaning hospital triage areas and providing high throughput for patient care are also important lessons learned. Usage of face shields and the quality of Personal Protective Equipment (PPE) should be ensured for all healthcare workers (HCWs). Resilient staff and resilient hospital infrastructure are crucial for a sustainable response to future pandemics. Full article

Background/Objectives: This study aimed to investigate the relationship between critical thinking disposition, clinical judgement, nurse–physician collaboration, and triage competency among triage nurses and to identify the factors influencing triage competency. Methods: This descriptive survey study included 152 triage nurses from one tertiary and six general hospitals. Data were collected from 1 September to 1 November 2023 and analysed using SPSS 29.0. Results: Triage competency was positively correlated with critical thinking disposition (r = 0.55, p < 0.001) and clinical judgement (r = 0.61, p < 0.001), while it was negatively correlated with nurse–physician collaboration (r = −0.52, p < 0.001). The hierarchical regression analysis showed that five variables, critical thinking disposition, clinical judgement, nurse–physician collaboration, education level, and years of experience in the emergency department, significantly influenced triage competency. The explanatory power of these variables for triage competency was 63.7% (F = 27.52, p < 0.001). Conclusions: Based on the findings, increasing the level of cooperation and fostering more cooperative relationships between nurses and physicians are necessary measures to improve their triage competency. Full article

Background: Artificial intelligence (AI) has been increasingly employed in healthcare across diverse domains, including medical imaging, personalized diagnostics, therapeutic interventions, and predictive analytics using electronic health records. Its integration is particularly impactful in critical care, where AI has demonstrated the potential to enhance patient outcomes. This systematic review critically evaluates the current applications of AI within the domain of critical care nursing. Methods: This systematic review is registered with PROSPERO (CRD42024545955) and was conducted in accordance with PRISMA guidelines. Comprehensive searches were performed across MEDLINE/PubMed, SCOPUS, CINAHL, and Web of Science. Results: The initial review identified 1364 articles, of which 24 studies met the inclusion criteria. These studies employed diverse AI techniques, including classical models (e.g., logistic regression), machine learning approaches (e.g., support vector machines, random forests), deep learning architectures (e.g., neural networks), and generative AI tools (e.g., ChatGPT). The analyzed health outcomes encompassed postoperative complications, ICU admissions and discharges, triage assessments, pressure injuries, sepsis, delirium, and predictions of adverse events or critical vital signs. Most studies relied on structured data from electronic medical records, such as vital signs and laboratory results, supplemented by unstructured data, including nursing notes and patient histories; two studies also integrated audio data. Conclusion: AI demonstrates significant potential in nursing, facilitating the use of clinical practice data for research and decision-making. The choice of AI techniques varies based on the specific objectives and requirements of the model. However, the heterogeneity of the studies included in this review limits the ability to draw definitive conclusions about the effectiveness of AI applications in critical care nursing. Future research should focus on more robust, interventional studies to assess the impact of AI on nursing-sensitive outcomes. Additionally, exploring a broader range of health outcomes and AI applications in critical care will be crucial for advancing AI integration in nursing practices. Full article

Emergency department (ED) overcrowding and limited staff availability pose ongoing challenges to healthcare efficiency. Recent advancements in automated health technologies, such as the health pod, aim to alleviate these pressures by automating vital sign measurements for low-risk patients. Over three months, the CAPSULA Health Pod was implemented and used in a paired setting with normal triage procedures in an urban hospital ED; it demonstrated improvements in triage efficiency and patient satisfaction, aligning with evidence that supports automation as a solution in high-demand healthcare settings. With 1342 assessments across 404 patients, despite some challenges with elderly patient engagement, CAPSULA achieved excellent measurement accuracy and relevant efficiency for the first assessment of patients in crowded situations and for reassessment. The findings indicate CAPSULA’s potential to reduce patient wait times, improve workflow efficiency, and support resource-limited EDs. Although the main limitation remains IT integration, the system demonstrates scalability and potential for broader adoption. Full article

Few evidence-based trainings exist on how to equip healthcare providers, particularly nurses, with the skills to engage in cost of care conversations with patients/caregivers to mitigate the impact of cancer-related financial toxicity. This study evaluated a pilot training developed in collaboration with Triage Cancer^® to prepare oncology nurses to identify and assist patients/caregivers facing financial and/or legal barriers to care. Ten pediatric oncology nurses completed the training and pre/post-surveys on behaviors related to financial and legal need screening, frequency and comfort level of answering questions, knowledge, and behavior changes, along with training evaluation questions. At baseline, six nurses reported never screening for financial needs and nine for legal needs. Following the training, seven nurses stated they were likely to screen for financial/legal needs. At six months post-training, nurses had referred 85 patients/caregivers to financial/legal navigation services. Comfort levels in answering financial/legal questions increased by 6.5 points and knowledge scores increased by 1.7 points post-training. Most nurses recommended this training to other healthcare providers who work with patients with cancer and their caregivers. This study highlights the importance of providing oncology nurses with resources to engage in cost of care conversations and oncology financial legal navigation programs to mitigate the impact of cancer-related financial toxicity. Full article

The accurate staging of breast cancer is fundamental for guiding treatment decisions and predicting patient outcomes. However, there can be considerable variation in routine clinical practice based on individual interpretation of guidelines and depending on the healthcare provider initially involved in working up patients newly diagnosed with breast cancer, ranging from primary care providers, triage nurses, surgeons, and/or oncologists. The optimal approach for clinical staging, particularly in asymptomatic patients presenting with intermediate-risk disease, remains a topic of dialogue among clinicians. Given this area of uncertainty, the Research Excellence, Active Leadership (REAL) Canadian Breast Cancer Alliance conducted a modified Delphi process to assess the level of agreement among Canadian expert clinicians on various staging recommendations. In total, 20 items were drafted covering staging based on biological status, the utilization of localization clips, both for the axilla during diagnosis and primary surgical site for margins and radiation therapy planning, and the use of advanced imaging for the investigation of distant metastases. Overall, the consensus threshold among all participants (i.e., ≥75% agreement) was reached in 20/20 items. Differences in clinical practice and recent findings from the literature are provided in the discussion. These consensus recommendations are meant to help standardize breast cancer staging practices in Canada, ensuring accurate diagnosis and optimal treatment planning. Full article

A stroke is a time-sensitive emergency, so diagnosing and treating the victim promptly is extremely important. Therefore, the purpose of this study was to identify the influence of the Stroke Code Protocol’s activation on the door-to-computed-tomography (door-to-CT) time and determine whether factors such as previous Modified Rankin Scale (mRS), age, and gender influence its activation. A retrospective study was conducted in a Medical-Surgical Emergency Department in the centre of Portugal from 1 January 2021 to 31 December 2022. The sample was selected according to the diagnosis assigned at the time of clinical discharge from the Emergency Department and the Stroke Code Protocol activation criteria. It was observed that 113 (50%) suspected stroke victims who met the activation criteria for the Stroke Code Protocol did not have the protocol activated, which had a highly significant influence (p < 0.001) on door-to-CT time. It was determined that activation at triage has an average door-to-CT time of 35 ± 18 min, post-triage activation has an average door-to-CT time of 38 ± 26 min, and non-activation has an average door-to-CT time of 1 h 04 ± 45 min. The need to implement an institutional protocol for activating the Stroke Code Protocol and provide specialised training for the multidisciplinary team is reiterated. Full article