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Triage Drift: A Workplace Study in a Pediatric Emergency Department


This paper presents a workplace study of triage work practices within an emergency department (ED). We examine the practices, procedures, and organization in which ED staff uses tools and technologies when coordinating the essential activity of assessing and sorting patients arriving at the ED. The paper provides in-depth empirical observations describing the situated work practices of triage work, and the complex collaborative nature of the triage process. We identify and conceptualize triage work practices as comprising patient trajectories, triage nurse activities, coordinative artefacts and exception handling; we also articulate how these four features of triage practices constitute and connect workflows, organize and re-organize time and space during the triage process. Finally we conceptualize these connections as an assessing and sorting mechanism in collaborative work. We argue that the complexities involved in this mechanism are a necessary asset of triage work, which calls for a reassessment of the concept of triage drift.

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  1. The scale is endorsed by the Canadian Association of Emergency Physicians (CAEP), National Emergency Nurses Affiliation of Canada (NENA) and L’association des Medecins d’urgence du Quebec (AMUQ).

  2. MD refers to Medical Doctor. Fellows working in the ED are MDs with pediatric as specialty in the process of becoming emergency physicians. Residents are MDs specializing in various areas not including pediatric emergency. They might be adult ED physicians or General practitioners who take a turn in a pediatric ED increasing their pediatric qualifications. Medical students are in the process of becoming MDs.

  3. Pediatric CTAS guidelines.

  4. During day time the charge nurse is a CNC: Clinical Nurse Coordinator.

  5. Resuscitation patients (CTAS 1) go directly to the trauma room for treatment and assessment without wasting time to fill out paper forms.

  6. In some case additional documents will also be started at triage, such as initiated nursing protocols or nursing x-ray orders. In these cases these extra documents will also be included in the package for the registration clerk.


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This study was conducted as a part of the research project ACTION for Health. ACTION for Health is funded by the Social Sciences and Humanities Research Council of Canada, Grant #512-2003-1017, titled ‘The role of technology in the production, consumption and use of health information: Implications for policy and practice’ with contributions from Simon Fraser University and Vancouver General Hospital.

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Correspondence to Pernille Bjørn.

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Bjørn, P., Rødje, K. Triage Drift: A Workplace Study in a Pediatric Emergency Department. Comput Supported Coop Work 17, 395–419 (2008).

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