Championing pediatric safety: Uncovering the hidden challenges of ED triage
In a pivotal study, San Rafael Emergency Department (ED) leaders Tina J. Vitale‑ McDowell, MSN, RN, CPEN, PECC, and Dana Sax, MD, have brought to light critical insights into the accuracy of triaging pediatric patients in the ED.
Their research, published in JAMA Pediatrics, reveals a troubling trend: nearly 60% of pediatric ED visits are overtriaged, and 7% are undertriaged, leading to significant consequences for patient safety, throughput, and the quality of care. Through their collaborative efforts, Vitale‑McDowell and Sax are championing improvements in pediatric care that are essential for protecting our young patients.
“This work is vital to support pediatric readiness and care in our EDs,” said Vitale‑McDowell. “It underscores our ethical responsibility to improve pediatric triage and ensure the safety of our most vulnerable population.”
A collaborative effort is now underway involving Regional Quality, Maternal Child Health, Pediatric Emergency Medicine, and the Division of Research to further examine the impacts of mistriage.
To understand the challenges faced during triage, front‑line staff from all 21 NCAL ED facilities are providing their insights.
“Emergency department triage is inherently a very challenging job. Triage nurses are asked to make triage assignments with limited time to take a history or review a chart, while simultaneously managing a busy waiting room and acting as the liaison between the waiting room and the back of the ED,” explained Sax. “We are learning more about how triage is currently done, how it impacts patient outcomes and ED operations, and we can better support our front‑line triage nurses in this difficult but critically important task of sorting patients on ED arrival.”
The focus ahead will be on refining triage processes to better safeguard patient safety and reduce health care disparities. The insights gained from these initiatives are instrumental in supporting our triage nurses, enhancing the care we provide to pediatric patients.
“This collaborative work is paving the way for more accurate and equitable care in our emergency departments, ensuring that every child receives the attention they need when they need it most,” said Vitale‑McDowell.
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