How to improve the Triage: A dashboard to assess the quality of nurses' decision-making

This paper presents a dashboard for assessing the quality of Triage decision-making process in the assignment of the priority code to patients arriving at an emergency department. The quality is assessed through performance indexes aimed at measuring both the nurses' accuracy and the presence of nurses' shared behavior in the Triage assignment process. The theoretical perspective of the cognitive heuristic, that is a cognitive shortcut strategy to make decisions, is the framework to design performance indexes of the dashboard. The dashboard has been tested in two Emergency Departments. We gather the data input through the submission to 54 nurses of a questionnaire, simulating 25 patients' scenarios. The dashboard reveals a disparity between nurses in priority level assignment. This disparity depends on nurses' capacity in disregarding some information and in considering the right cue. We find the presence of sharing behaviors and inclination to over or under assessment by nurses. This performance analysis, integrated with the nurses' reasoning in assigning the priority code, can address the management in designing improvement actions at individual level and at the organizational one. In addition, the application to two Emergency Department confirms the influence of organizational aspects in the individual decision process.