Advances in Health Sciences Education

, Volume 13, Issue 4, pp 503–520 | Cite as

Calibrating urgency: triage decision-making in a pediatric emergency department

  • Vimla L. PatelEmail author
  • Lily A. Gutnik
  • Daniel R. Karlin
  • Martin Pusic
Original Paper


Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.


Triage Decision-making Emergency department Nursing education Clinical guidelines 



The research reported in this paper was supported by a grant from the Medical Research Council of Canada to Vimla Patel (MRC-MA-13439) and in part through the Department of Biomedical Informatics at Columbia University, New York. We would like to thank the participants in this study, and the nursing staff of the Emergency Department at McGill University, Montreal who made this study possible. We also wish to acknowledge David Kaufman and Laurie Barkun for their assistance with data collection and the development of the interview guide; and Eneida Mendoca and Elizabeth Nehemiah for their comments during the revision process.


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Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • Vimla L. Patel
    • 1
    Email author
  • Lily A. Gutnik
    • 1
  • Daniel R. Karlin
    • 1
  • Martin Pusic
    • 2
  1. 1.Laboratory of Decision Making and Cognition, Department of Biomedical InformaticsColumbia University Medical CenterNew YorkUSA
  2. 2.Division of Pediatric Emergency Medicine, Department of PediatricsColumbia UniversityNew YorkUSA

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