Improving Pediatric Respiratory Triage Accuracy: A Quality Improvement Project 206 views

Abstract: - Objectives: To improve triage accuracy among pediatric nurses in a large academic medical center’s pediatric emergency department using the Emergency Severity Index (version 5), with a focus on patients presenting with respiratory chief complaints. - Methods: A nurse-focused intervention targeting respiratory triage was implemented using three Plan-Do-Study-Act Cycles over two months, followed by a three-month sustainability phase. Data collection was through retrospective chart review of patients aged 0-18 years presenting with respiratory chief complaints. Triage accuracy was assessed by comparing assigned triage levels with expected resource utilization and established triage criteria. - Results: Baseline respiratory mistriage rate was 40.5%. Following implementation, mistriage decreased across cycles, reaching 30.6% by the third cycle. Improvements were sustained during the post-implementation phase, with mistriage rates of 27.3%, 30.3% and 22.2%. - Conclusions: Targeted nurse education on triage algorithms and respiratory-specific considerations was associated with improved triage accuracy. Improved accuracy may enhance resource allocation, patient outcomes, and nurse confidence in triage decision-making. These findings support the use of structured quality improvement interventions to address high-risk presentations in pediatric emergency care.

DNP (Doctor of Nursing Practice)

Pediatric; Triage; ESI; Respiratory; Emergency Severity Index; Emergency Department; Nursing

English

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2026-04-28