Digital Repository Masters Projects Spring 2025 Back to Basics: The Importance of Triage Education Chelsey Alliger Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Alliger, C. 2025. Back to Basics: The Importance of Triage Education Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 WSU REPOSITORY MSN/DNP Back to Basics: The Importance of Triage Education Project Title by Chelsey Alliger Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 4.26.25 Ogden, UT Date Chelsey Alliger Student Name, Credentials (electronic signature) 4.26.25 Date Trish Gibbs DNP, RN, CNE 4.26.25 MSN Project Faculty Date (electronic signature) Anne Kendrick DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 4.26.25 Date 2 Back to the Basics: The Importance of Triage Education Chelsey Allgier, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 3 Abstract Purposes/Aims: This project aims to identify factors that affect triage acuity accuracy, educate nursing staff to improve accuracy, and boost staff confidence in triaging. By addressing these factors, we aim to reduce under- and over-triage, which can have serious patient consequences. Rationale/Background: Despite the known importance of triage accuracy, current accuracy rates vary between 59.2% and 82% (Suamchaiyaphum et al., 2024). Under-triage and over-triage of patients can have detrimental consequences such as a twofold increase of complications and mortality with under-triaged patients. Methods: The project will provide a PowerPoint review, pre- and post-tests, and confidence surveys to fill knowledge gaps and offer yearly updates on the Emergency Severity Index (ESI). Pre- and post-tests will assess staff knowledge and confidence, and post-education surveys will gather feedback on the training. Results: Once this project is implemented, the goal is to enhance nurses' confidence in accurate triaging, reduce bias related to patient factors, and improve the work environment, ultimately improving triage accuracy (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023; Won-Oak & Myung-Jin, 2024). Conclusions: Education specifically targeted at current, evidence-based practice while triaging and reducing bias can increase accuracy rates when assigning acuity levels. Keywords: triage, nursing education, work environment, patient factors 4 Back to the Basics: The Importance of Triage Education The acuity level assigned by the triage nurse is a critical factor that influences the patient's emergency room visit and the subsequent hospital stay. Under-triaging of patients has been shown to increase complications two-fold and significantly contribute to patient mortality. Conversely, over-triaging can lead to misallocations of resources, increase the cost of patient care, and create staff burnout (Patrick et al., 2023). Despite the proven effectiveness and reliability of the Emergency Service Index (ESI), the accuracy rates vary widely, ranging from 59.3% to 82% among emergency departments (Suamchaiyaphum et al., 2024). Additionally, different factors such as socioeconomic status, insurance status, gender, and race were assessed to determine their impact on triage accuracy (Patrick et al., 2023). This literature review, which aims to identify common themes that negatively impact the accuracy of triage acuities, presents compelling evidence that supports the need for continuous improvement in triage practices, particularly in preventing under-triaging in the Emergency Department. Hang and Shin (2023) emphasize the importance of interpersonal relationships and improving collaboration among nurses and physicians. Finally, research suggests the need to eliminate frequent interruptions and provide as calm an environment as possible to reduce mistakes made by triage nurses (Bijani & Khaleghi, 2019). Statement of Problem Research supports that triage accuracy directly impacts the care patients receive while being treated in the Emergency Department, as well as the care delivered during inpatient hospitalization and outpatient follow-up visits (Rashid et al., 2021). Despite the importance of triage accuracy, current accuracy rates remain between 59.2% and 82% (Suamchaiyaphum et al., 5 2024). Evidence suggests that various factors can influence a triage nurse, such as noisy, chaotic environments, multiple interruptions, emotional burnout, and fatigue, all of which can lead to mistakes (Bijani & Khaleghi, 2019). Moreover, patient characteristics have also correlated to triage accuracy, such as their socioeconomic status, gender, race, and medical insurance status (Patrick et al., 2023). Hang and Shin (2023) recommend enhancing collaboration and support between physicians and nurses to support improved triage competence (p=.009). Therefore, this MSN project aims to improve the triage education nurses receive while boosting nurses' confidence levels with the goal of increasing accuracy rates. This goal will be accomplished by examining current literature to determine the extent of the problem and identify best practices. Research findings will be used to develop and implement an educational program for nurse leaders emphasizing triage education, the importance of reinforcement, and ongoing training. Significance of the Project The significance of this project must be balanced due to the importance the triage nurse plays when determining the trajectory of a patient's hospital visit. For example, the triage nurse decides whether a patient is critical, emergent, or stable enough to wait to be seen by a clinician. This project is essential as it provides invaluable nursing education emphasizing the Emergency Severity Index (ESI) used in most Emergency Departments in the United States (Patrick et al., 2023). Furthermore, this project aims to boost triage nurses' confidence levels when dealing with emergencies to improve patient outcomes, provide safer care, and appropriately utilize department resources to reduce staff burnout. The project ultimately seeks to educate triage nurses on reducing errors by minimizing interruptions, understanding available resources and 6 how to use them, and fostering a work environment that mitigates the risk of overwhelming nurses, which can lead to patient harm. Review of the Literature The acuity level assigned to a patient by the triage nurse plays a crucial role in determining their experience in the emergency room and their subsequent hospital stay. While the Emergency Service Index (ESI) has demonstrated effectiveness and reliability, its accuracy rates vary significantly, ranging from 59.3% to 82% across emergency departments (Suamchaiyaphum et al., 2024). Additionally, socioeconomic status, insurance coverage, gender, and race may influence the accuracy of triage assessments (Patrick et al., 2023). This literature review seeks to identify common themes that adversely affect triage accuracy, providing strong evidence for ongoing improvements in triage practices, particularly to mitigate the risk of undertriaging in the Emergency Department. Framework The 'Plan, Do, Study, Act' (PDSA) model is a reliable tool for achieving quality improvement. It starts with developing a plan for quality improvement or as a solution to a current problem. The plan is then executed while observers collect data and results of the test. Once the observers disseminate the results, the team can implement the originally proposed solution or modify it as needed based on the data. If the team decides to modify the solution, they restart the cycle until a satisfactory solution is obtained. Healthcare institutions have widely accepted the PDSA model due to its simplistic and realistic qualities (Chen et al., 2024). 7 Annette Elliott, a Nurse Educator with Minnesota State College Southeast, found PDSA to be an effective model for delivering quality improvement learning outcomes to her students. Annette asked her eleven students to complete questions from a learning guide and attend a classroom lecture focused on a safety or quality issue that must be addressed. After identifying a problem, un-utilized volunteer staff, the students then implemented the Plan-Do-Study-Act model to determine the proper scopes of volunteers. The students created a draft for standardized volunteer work practices and studied the effectiveness with patients and unit staff members. Upon completion of the project, Annette found the PDSA approach effective in achieving her students' desired learning outcomes (Elliott, 2024). Strengths and Limitations PDSA has multiple strengths when applied in healthcare due to the model's simplicity. This model has been endorsed by the Institute for Healthcare Improvement (Chen et al., 2021). This allows healthcare teams to implement changes on a small scale, evaluate their impact, and make necessary adjustments before broader implementation. The PDSA cycle promotes continuous learning and process improvement, enabling healthcare organizations to meet everevolving patient needs and challenges. Additionally, the PDSA model fosters collaboration among teams, enhancing communication and teamwork, which Hwang and Shin (2023) support as necessary to improve the accuracy of triage acuity levels. However, the PDSA model also has its limitations. One significant challenge is the potential for insufficient time and resources to carry out the cycles effectively. In fast-paced healthcare environments, staff may prioritize immediate duties over quality improvement goals, leading to incomplete cycles and incorrect data. Furthermore, the reliance on data collection and 8 analysis can be challenging, mainly if data is not readily available or if staff lack the training to interpret it accurately. This issue can also result in misleading conclusions impacting proposed changes in the workplace. Lastly, while PDSA promotes engagement among staff, it may also create resistance to change if employees feel overwhelmed by continuous cycles of improvement or perceive them as additional burdens rather than opportunities for enhancement (Chen et al., 2021). Analysis of Literature Through a comprehensive literature search, three major themes were identified to address the PICOT question: For nurses who perform triage, does orientation and triage question sets compared to no orientation or triage question sets affect nursing confidence on ESI acuities over six to twelve months? One of the themes that strongly advocates for improved triage accuracy is the importance of continued nursing education in solidifying the understanding of ESI levels. The second theme highlights how chaotic work environments with frequent interruptions can lead to errors and reduce the accuracy of triage acuity levels. The third theme underscores the critical role of providing adequate psychological support in helping the triage nurse assign appropriate acuity levels in triage. Finally, multiple studies have validated the increased risk of patients being under-triaged due to their age, socioeconomic status, insurance status, and race/ethnicity (Patrick et al., 2023; Sudarshan et al., 2024). Search Strategies A literature search was conducted using Google Scholar, PubMed, and Medline databases. Only articles from 2019-2024 were included in this literature review to provide the 9 most current and relevant information. The database search included keywords such as triage accuracy, the importance of triage accuracy, barriers to triage accuracy, under-triaging, consequences of under-triaging, education for triaging, factors that affect triage accuracy, patient socioeconomic status and under-triaging, and triage of racial and ethnic disparities. Synthesis of the Literature Synthesis of the literature highlights the crucial role of nurse education and experience in the accuracy of triage acuity levels. Studies, including those by Suamchaiyaphum et al. (2024), emphasize that knowledge, experience, and skill set significantly influence triage accuracy. Hwang and Shin (2023) further underscore the need to enhance triage competency, particularly in clinical reasoning skills, which is statistically supported (p < .001). Research by Won-Oak and Myung-Jin (2024) confirms that perceived triage competency and clinical reasoning are significant predictors of accuracy, with a notable statistical relationship (F = 8.990, p < .001). Rashid et al. (2021) also stress the importance of clinical reasoning, revealing that factors like age and abnormal vital signs increase the risk of under-triaging. Several studies recommend specific training for nurses, particularly those with at least one year of emergency experience and relevant certifications, to ensure ongoing competency (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023; Won-Oak & Myung-Jin, 2024). Bijani and Khaleghi (2019) identify work environment factors that negatively affect triage accuracy, such as high stress, increased workloads, and personnel shortages, leading to overcrowding and interruptions. Interestingly, Suamchaiyaphum et al. (2024) report a positive correlation between triage accuracy and increased workload (r = 0.11, p = .03), suggesting that the relationship is complex. 10 Hwang and Shin (2023) propose developing strategies to reduce workplace stress that could adversely affect triage accuracy (p = .007). Bijani and Khaleghi (2019) highlight the necessity for triage nurses to possess emotional stability and the ability to remain calm under pressure. Suamchaiyaphum et al. (2024) note that chaotic environments can overwhelm nurses, leading to mistakes due to distractions and emotional fatigue. Finally, Hwang and Shin (2023) advocate for enhanced collaboration and support between nursing and medical staff to improve triage competencies (p = .009). Nursing Education Multiple studies have expanded on the importance of nurse education and experience and how they impact the accuracy of triage acuity levels (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023; Won-Oak & Myung-Jin, 2024; Bijani & Khaleghi, 2019; Rashid et al., 2021). For example, Suamchaiyaphum et al. (2024) report that nurse characteristics such as knowledge, experience, and skill set significantly impact their triage accuracy. Research by Hwang and Shin (2023) supports a significant need to improve triage competency with a specific emphasis on clinical reasoning skills (p < .001). Moreover, in a cross-sectional study by Won-Oak and Myung-Jin (2024), 157 nurses in South Korea responded to questionnaires to determine perceived triage competency and clinical reasoning, which ultimately proved to be significant predictor factors on triage accuracy (F = 8.990, p < .001). Further, clinical reasoning is also shown to be critical by Rashid et al. (2021), as their study validated that increasing age and abnormal vital signs such as severe bradycardia, tachycardia, and hypoxia were at greater risk of being under-triaged. Finally, 11 research findings recommend hospitals educate nurses on triage who have at least one year of emergency nursing experience, have an emergency nursing certificate, and receive continuous education and training for triage (Suamchaiyaphum et al., 2024; Rashid et al., 2021; Won-Oak & Myung-Jin, 2024). Work Environment Bijani and Khaleghi (2019) highlighted multiple factors involving the work environment that could negatively impact triage accuracy. For example, a highly stressful work environment with higher workloads and personnel shortages leads to overcrowding of patients in triage, ultimately increasing interruptions and errors with assigned acuities (Bijani & Khaleghi, 2019). Conversely, Suamchaiyaphum et al. (2024) reported a positive correlation of triage accuracy when nurses were burdened with an increased workload (r = 0.11, p = .03). Lastly, Hwang and Shin (2023) suggest that the workplace construct a solid plan to reduce work-related stress and burden that has the potential to impact triage accuracy negatively (p = .007). Providing Psychological Support Bijani and Khaleghi (2019) emphasize the importance of emotional stability, high tolerance, and the ability to remain calm in chaotic situations, which are characteristics the triage nurse must possess. Suamchaiyaphum et al. (2024) further report that noisy, crowded, and chaotic environments can cause the nurse to feel overwhelmed, and distractions can disrupt the nurse's concentration, leading to increased mistakes. Emotional burnout and fatigue can further lead to inaccuracy (Suamchaiyaphum et al., 2024). Moreover, Hwang and Shin (2023) recommend enhancing collaboration and support between personnel, specifically 12 between physicians and nurses, to support improved triage competence (p = .009). Summary of Literature Review Findings and Application to the Project A detailed review of current literature on the importance of triage education revealed the significance of nurse education and experience on the accuracy of triage acuity levels. Fundamental studies highlight that knowledge, clinical reasoning skills, and expertise are crucial for effective triage, with evidence supporting the need for improved training (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023). Research indicates that perceived triage competency and clinical reasoning significantly predict accuracy, while factors such as age and abnormal vital signs increase the risk of under-triaging (Won-Oak & Myung-Jin, 2024; Rashid et al., 2021). Recommendations include training for nurses with at least one year of emergency experience and relevant certifications. Work environment factors, like high stress and personnel shortages, are identified as detrimental to triage accuracy (Bijani & Khaleghi, 2019). Interestingly, a complex relationship exists between workload and accuracy, with some studies indicating a positive correlation (Suamchaiyaphum et al., 2024). Finally, fostering collaboration and support between nursing and medical staff is suggested to enhance triage competencies (Hwang & Shin, 2023). Overall, the findings indicate the need for ongoing education and a supportive work environment free from frequent interruptions to improve triage accuracy. Project Plan and Implementation The project plan and implementation consist of creating evidence-based educational materials for nurses with more than a year of emergency nursing experience to optimize their critical thinking when assigning acuity levels during triage. This project benefits emergency department nurses as it ensures patients receive timely care for critical conditions. The education 13 materials will focus primarily on common emergency conditions seen in the Emergency Department and resources to combat an unsafe work environment. Furthermore, question sets will be created for nurses to use as tools during triage. These tools will consist of common critical conditions that require timely responses, such as chest pain and shortness of breath. Finally, assessment tools will be developed to evaluate nurses’ comfort level regarding different aspects of triage and their competency level when triaging patients. The Plan-Do-Study-Act (PDSA) framework will effectively guide the project plan and implementation to improve triage accuracy rates. In the Plan phase, the team would outline the goals of improving triage accuracy, assess the current process, identify key areas for improvement, and develop a strategy, including training programs and decision support tools. The Do phase would involve implementing the plan by introducing new training, tools, and processes and conducting an initial test to evaluate their impact. In the Study phase, the team would gather data, analyze results, and compare the outcomes with initial accuracy targets. This phase would also include gathering feedback from staff to identify any challenges or areas that need improvement. Finally, in the Act phase, based on the insights from the Study phase, adjustments would be made to the processes, tools, or training programs to enhance effectiveness. This iterative process would ensure continuous improvement, allowing the team to make data-driven decisions and refine the approach until the desired triage accuracy rates are achieved utilizing evidence-based practices (Chen et al., 2021). Plan and Implementation Process The project plan and implementation involve developing educational materials aimed at enhancing the critical thinking skills of nurses with over a year of experience in emergency 14 nursing, specifically when assigning acuity levels during triage. The materials will focus on common emergency conditions encountered in the Emergency Department and provide resources to address challenges posed by a less-than-ideal work environment with distractions. Following implementation, data will be obtained through chart audits and surveys from triage nurses to identify areas where further training is needed or where nurses may feel uncertain. The project will then be evaluated by assessing the before-and-after competency and comfort levels of triage nurses. Additional support will be needed through the collaboration of unit managers and physicians to aid in project implementation. The implementation process consists of first asking nurses to complete a pre-test to evaluate skill level before training begins. Next, an overview of the triage nurse policy specific to the Veteran Affairs Emergency Department will be provided. For those nurses who have been practicing in the triage role, this will serve as a refresher course. For new nurses with less than a year of experience, this will provide a baseline to help guide them in the development of triage skills. After reviewing the PowerPoint and policy, new nurses will be assigned a shift with a preceptor to practice triaging patients by assigning acuity levels. Finally, new triage nurses and senior triage nurses will complete a post-test, where a grade of 80% or better is required to pass. The literature reviews support this approach by emphasizing the need for solid foundational training in triage for newer nurses as well as continued yearly refreshers (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023). Interdisciplinary Team The primary healthcare workers involved in my project consist of triage nurses with one year of emergency department experience. However, this plan also requires input from 15 physicians, techs, and managers, as enhancing collaboration among staff is noted to benefit triage nurses when assigning appropriate acuity levels (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023). Description and Development of Project Deliverables For project success, there are five project deliverables that will be developed. Based on current evidence, these resources will aid in nurse’s successful training for the triage role (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023). The six deliverables to be used are the following: (1) a PowerPoint presentation regarding the importance of understanding ESI and common medical and traumatic conditions seen in emergency departments, (2) a triage orientation layout to simplify the orientation process, (3) a pre-test used to evaluate current baseline knowledge, (4) a post-test to evaluate knowledge obtained after the training, (5) a remediation test if needed for a score less than 80%. The following sections will explain all five deliverables and discuss their importance to the project. Powerpoint Training This training provides a detailed overview of the triage process and the importance of accuracy when training. This training teaches the potential negative consequences of under- or over-triaging a patient. Furthermore, this training discusses possible reasons a patient might be under-triaged, such as gender, age, race, and/or socioeconomic status. Also, a detailed and thorough explanation of Emergency Severity Index Version Five is given, as well as how acuity is determined using this system. Finally, there is a review of common medical and traumatic conditions seen in the Emergency Department with case study questions provided (See Appendix D). 16 Triage Orientation Layout The second deliverable guides the orienting triage nurse through the process in a clear manner to prevent confusion and ensure the training is fully completed. This deliverable is then placed in their file once completed for future auditing by accreditation groups when needed (See Appendix B). Pretest The third deliverable consists of five scenario-based questions serve to evaluate the nurse’s knowledge level and skills prior to completing the training. This test, while mandatory for the implementation of this project, does not have a requirement percentage to advance to the next step in the training. These questions all require the nurse to assess the given information and provide an acuity level (See Appendix C). Post-Test and Remediation Testing The fourth and fifth deliverable includes a post-test (See Appendix D) consisting of ten questions and a remediation test if a nurse received less than an 80% on the post-test. These tests will be created to assess the nurse’s ability to function successfully in the triage nurse role. The pre and post test scores will be inputted into an Excel spreadsheet and results will be compared for improvement after the triage education is completed. In this test, the nurse is required to obtain an 80% or higher to complete the training. If a nurse does not meet 80%, further education, and assistance will be provided with rationales for the questions answered incorrectly on the test. The nurse will then take a remediation posttest with an 80% required to pass (See Appendix E). Timeline 17 The proposed timeline consists of six months for training to be implemented within the facility. This proposed timeline allows for newer staff to be oriented to the triage role as well as provide refresher courses to senior triage nurses within the department. Our unit will provide inservices for any policy implementation, and this can potentially lengthen the timeline. This project may expand to one year for continued chart audits and continued education as needed (see Appendix F). The first month will focus on assessment and analysis to improve triage accuracy rates over the next six months. A review of the current triage process will be completed to identify key metrics such as time to triage and accuracy rates. Data will be gathered from past cases, triage personnel interviews will be completed, and reports on the findings will be analyzed to prioritize areas for improvement. In the second month, a comprehensive strategy for improvement will be developed, addressing areas like decision-making tools, staff training, and standardization. A detailed training plan will be created to bridge knowledge gaps and introduce updated triage protocols or decision support tools. The training program will be implemented in the third month, and decision support tools such as algorithms or triage question sets will be introduced. Staff will be trained on how to use these tools effectively. The Master Preceptor or a proficient triage nurse will train and orient staff, this training should ideally should take approximately two hours to complete, followed by as many staff-assisted triages needed for the new triage nurse to feel comfortable and confident. In the fourth month, a pilot test with the new processes will be tracked, and the results and feedback from triage staff will identify any challenges or issues. Upon completion of the 18 pilot test, it will be important to refine the training program based on feedback from the initial testing to optimize processes, promote smoother collaboration, and ensure consistency among the team. Finally, performance will be monitored, and progress will be tracked toward the set accuracy rate goals in the sixth month. The nurse leader will then evaluate whether the target improvements have been achieved and make final adjustments to processes, training, or tools as needed, ensuring long-term improvements. Continual monitoring and feedback will be needed as evidence-based practices evolve. Project Evaluation This project will have continued evaluation of the effectiveness of the training, including chart audits to measure nurses’ triage acuity accuracy before the training as well as post-training. The nurses will also be asked to complete a pre-test before the training to assess current standing by assigning acuity levels and taking a post-test after the training. The nurses must complete the post-test with an eighty percent or greater to pass. If their score is not passing, they will receive more training on an individual basis. This student will then take a remediation test (See Appendix F). Chart audits will continue to ensure the effectiveness and sustainability of the training. Formative evaluation occurs during the training process and aims to monitor and improve the training while it is in progress. This project's formative evaluation includes the pre-test, which assesses nurses' baseline knowledge of acuity level assignment before the training. This initial assessment will identify any existing knowledge gaps and allow adjustments to the training program to address these gaps. Ongoing chart audits will also be part of the formative 19 evaluation, helping to track nurses' performance in real-time and offering opportunities for timely feedback. If a nurse scores below 80% on the post-test, they will undergo individualized remediation to ensure they meet the required competency, reinforcing formative feedback. The summative evaluation assesses the training program's overall effectiveness after completion. In this project, the post-test is the primary summative evaluation tool, determining whether nurses have gained sufficient knowledge to assign triage acuity levels accurately. To pass, nurses must score 80% or higher, ensuring they are competent in triage practices. Chart audits conducted after the training will also serve as a summative measure, comparing pre- and post-training accuracy to evaluate the sustained impact of the education. These evaluations will provide comprehensive feedback and measure the training's immediate and long-term effects, ensuring its effectiveness and sustainability. Ethical Considerations This project empowers nurses to provide patients with non-discriminatory care. Ethical considerations include racial and socioeconomic status, as these have been determined to influence a triage nurse to potentially under-triage a patient, causing further harm and a two-fold risk of complications (Suamchaiyaphum et al., 2024). The training addresses and requires the triage nurse to not take these factors into consideration. The training provides education on different types of bias seen in healthcare and allows the nurse to reflect on potential situations where they have seen bias negatively impact patient care and how to avoid this during future triaging. The information is presented in a PowerPoint presentation with the intention of providing education and orientation to the triage role. This training emboldens triage nurses to show social responsibility and honesty when making critical decisions by reintroducing 20 foundational knowledge, encouraging the triage nurse to make decisions based on presentation vs. discriminatory factors such as race, age, gender, and/or socioeconomic status, and providing support to the triage nurse to reduce work burnout and fatigue. The triage nurses need to be able to think critically and make decisions without bias of race, gender, and/or socioeconomic status (Suamchaiyaphum et al., 2024; Hwang & Shin, 2023; Quellet et al., 2022; Cetin et al.; Seo et al., 2024). This training is required for all nurses within my department. However, the privacy of the nurses and patients will be confidential and maintained within this study. This information will be tracked on an Excel document kept confidential from unauthorized use on protected government computers. Discussion A review of current literature on the importance of triage accuracy validates the crucial need for continued nursing education to solidify a solid understanding of ESI levels (Suamchaiyaphum et al., 2024; Smith et al., 2022; Schwing et al., 2019). Additionally, chaotic work environments can decimate the triage nurse's ability to assign acuity levels accurately. Finally, inadequate psychological support can further lead to disruptions and errors in decisionmaking and critical thinking. Suggestions from the literature as potential solutions include providing initial and continued education, creating a solid plan to help reduce work-related stress, and enhancing collaboration and communication between physicians and nurses (Suamchaiyaphum et al., 2024; Smith et al., 2022; Schwing et al., 2019). This project will utilize and implement the above evidence-based recommendations to empower and support triage nurses to improve triage accuracy. Evidence-based Solutions for Dissemination 21 After implementing this project, the results will be disseminated in several ways. The following data will be gathered and analyzed: staff pre-survey evaluation, posttest evaluation, and chart audits of triage accuracy rates. The data results will be shared with the nursing leadership team for evaluation and discussion if this project has the potential for continuation. The survey information, data on triage accuracy rates, and utilization of educational materials will help the nursing leaders identify whether this project is valuable and will serve as a guide to making changes to improve the project's objectives. Once the nursing leadership team approves the project, the coordinator will present the results to the Emergency Department stakeholders during the staff meeting. Finally, the coordinator will present and discuss this MSN project using a poster presentation to Weber State University Annie Taylor Dee School of Nursing faculty and peers. If this project's findings are significant, then it will be submitted for journal publication. Significance to Advance Nursing Practice This project can significantly benefit the nursing profession by improving the accuracy of triage acuity assignments, which directly impacts patient care and outcomes (Suamchaiyaphum et al., 2024; Smith et al., 2022; Schwing et al., 2019). By addressing knowledge gaps, educating staff, and boosting confidence, the project helps ensure patients receive the appropriate level of care based on severity. Accurate triage can reduce the risks associated with under and overtriage, such as increased complications and mortality (Suamchaiyaphum et al., 2024; Smith et al., 2022; Schwing et al., 2019). Research also shows that education and bias reduction can enhance decision-making and nursing effectiveness (Liu et al., 2021; Smith et al., 2022). Implications 22 Strengths of the project include its evidence-based approach and the focus on improving nurse confidence, which can lead to improved triage accuracy. However, potential limitations include variations in staff willingness to adopt new practices or the time required to implement and sustain educational requirements. To address these obstacles, regular refresher courses and integrating the training into annual nursing education programs can ensure continued improvement. The project will support nursing knowledge by providing evidence-based practices for triage accuracy and fostering a culture of continuous learning in nursing. Recommendations To improve the project, additional training on the psychological factors influencing triage decisions, such as stress or cognitive overload, could be incorporated. Faculty and peer feedback suggest including case studies or simulations to further engage staff in realistic triage scenarios. Further research may explore the long-term effects of this education on triage accuracy or its impact on patient outcomes over time. Conclusions The project successfully highlighted the importance of triage accuracy and the factors influencing it, including nurse knowledge and confidence (Suamchaiyaphum et al., 2024; Smith et al., 2022; Schwing et al., 2019). The education and training provided can improve triage practices and reduce patient harm. Key findings show that evidence-based training and bias reduction can significantly enhance nursing practices and improve patient outcomes in triage settings (Suamchaiyaphum et al., 2024). 23 References Bijani, M., Khaleghi, A. (2019). Challenges and barriers affecting the quality of triage in emergency departments: A qualitative study. 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