JMIR Publications

ABSTRACT

Background:

Emergency Departments (EDs) use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and unstructured (free text) data. Free text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner.

Objective:

The objective of this paper is to identify and map the academic literature that examines triage narratives. It describes the types of research conducted, identifies gaps in the research, and determines where additional review may be warranted.

Methods:

We conducted a scoping review of unstructured triage narratives. We mapped the literature and described use of triage narrative data, information available on form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research.

Results:

We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 96 studies that directly examined the use of triage nurse narratives. There were over 12 million ED visits, generated by 2,438 EDs included in the review. More than 80% (n=79) of these studies were performed in the United States (n=43, 45%), Australia (n=31, 32%), or Canada (n=5, 5%). Triage narratives were used for research, case identification, as input variables for predictive modeling, and for quality improvement. One third (31%) of studies offered a description of the triage narrative, including a list of keywords used (n=27, 28%) or more fulsome descriptions (such as wordcounts, character counts, abbreviation uses, etc.) (n=7, 7%). We found limited use of reporting guidelines (n=8, 8%).

Conclusions:

The breadth of studies identified suggest there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and the nurses who generate them are poorly described in the literature and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives; to determine the best use of triage narratives, and to improve the consistent use of triage-specific data reporting guidelines.