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14

he role of triage nurses in improving outcomes for acutetroke patients

ulia Morphet1,∗, Kelli Innes2,∗, George Braitberg3, Ianosley2

School of Nursing and Midwifery, Monash University, POox 527, Frankston 3199, AustraliaSchool of Nursing and Midwifery, Monash University,ellington Road, Clayton 3800, AustraliaSouthern Health, Emergency Department Dandenong, POox 478, Dandenong 3175, Australiaeywords: Emergency nursing; Triage; Stroke; Research

-mail addresses: julia.morphet@monash.edu (J. Morphet),elli.innes@monash.edu (K. Innes),eorge.braitberg@southernhealth.org.au (G. Braitberg),an.mosley@monash.edu (I. Mosley).

Background: Rapid care protocols to reduce in-hospitalime to treatment and improve patient outcomes followingtroke symptom onset are now common place in Emergencyepartments (ED). We set out to investigate stroke presen-ations, triage assessments and triage categories allocatedo stroke patients in the ED.

Specifically to:

identify stroke recognition and triage category allocationat triage, andidentify factors associated with triage category 1 or 2among stroke patients who present within two hours fromsymptom onset.

Methods: A retrospective assessment of ED records foratients presenting to one of three Southern Health hos-itals (Melbourne) over a six month period in 2010 wasndertaken. Included patients had a final ED medical diag-osis of stroke or TIA.

Results: 798 patients were included in this study; 469ith stroke and 329 with TIA. Among patients who pre-

ented within two hours (n = 185), 173 (94%) were identifieds stroke at triage and 132 (71%) were allocated a triageategory 1 or 2. Facial weakness and presentation to Monashedical Centre were significantly associated with triage cat-gory 1 or 2. Patients with resolving symptoms were lessikely to be allocated triage category 1 or 2.

Conclusion: Triage nurses play a vital role in the recogni-ion and timely activation of rapid acute stroke protocols.irtually all acute stroke patients were identified at triage,owever over 30% were not allocated a triage category 1r 2. Further education may be required to ensure that the

ational Stroke Foundation guidelines are implemented forcute stroke patients.

oi:10.1016/j.aenj.2011.09.036

d

clinical handover study: Patients arriving by ambulanceo a South East Queensland hospital emergency depart-ent

erolie Bost1,∗, Julia Crilly1, Wendy Chaboyer2

Emergency Department, Gold Coast Hospital & RCCCPI,riffith University, 108 Nerang Street, Southport, Qld.215, AustraliaNHMRC Centre of Research Excellence in Nursing Inter-entions for Hospitalised Patients (NCREN), Griffith Healthnstitute, Gold Coast Campus, Griffith University, Qld 4222,ustraliaeywords: Handover; Ambulance; Emergency department;ualitative research

-mail addresses: nerolie bost@health.qld.gov.au (N. Bost),ulia crilly@health.qld.gov.au (J. Crilly),.chaboyer@griffith.edu.au (W. Chaboyer).

Aim: The aims of this study were to explore: (1) the clini-al handover processes between ambulance and emergencyepartment (ED) personnel and; (2) to identify factors thatmpact on the information transfer.

Method: A focused ethnography was used and involvedbservation of 38 handovers, 21 informal conversationalnterviews and examination of handover tools. Data wereollected from May to December 2008. Participants included4 ambulance paramedics, 30 nurses and 10 doctors fromn ambulance service and regional hospital located inouth East Queensland, Australia. Analysis used an inductivepproach and the data were coded and sorted into cate-ories of information using the constant comparison method.ll participants provided informed consent.

Principal findings: Two types of clinical handover weredentified. Quality of information transferred was depen-ent on a number of factors including: the patients’ reasonor attendance, the individual staff members’ expectations,ducation, prior experience, workload and busyness of theD. Repetition of handover to ED personnel and lack ofctive listening were issues identified by some participants.he time of transfer of patient responsibility was unclearetween the two organisations.

Implications: This study identified that providing clinicalandovers between two organisations with different cul-ures and backgrounds in a busy environment has uniquehallenges. In this ED, the quality of clinical handover maye improved through shared training programmes involv-ng the use of guidelines, tools such as a whiteboard and a

oi:10.1016/j.aenj.2011.09.037