RAPID:Triaging decisions during catastrophic events: a study of frontline triage nurses

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The goal of this RAPID project is to model decision-making among nurses when they triage patients during the COVID-19 pandemic. Triage nurses act as frontline gatekeepers and perform a difficult balancing act during a pandemic. They must not only ensure that patients who need immediate care get it in a timely manner but must also filter incoming patients to prevent infections and to reduce undue burden on hospital resources. The complexity and risk in their decisions are influenced by how the nurses themselves perceive the risk of a pandemic, and how they associate and project their risk perception with the information a patient provides. Conventional triage decision making criteria, protocols and processes based only on a linear, discrete, “single-symptom at a time” risk screening approach are woefully inadequate to tackle triage decisions in a pandemic of this scale and complexity. Nurses play a pivotal role in ensuring safe and timely patient care and in limiting the spread of COVID-19-like pandemics. The knowledge gained from this project about decision making and evidence-based practices during crises will benefit organizations worldwide, by proving data on factors that make decision-making. These data can drive training and guidelines development. Triage nurses routinely make triage decisions about patients. But, during a pandemic, they make particularly complex and risky decisions. Triage decision making criteria and protocols must reflect a deep understanding of how nurses weigh patient symptoms, and match them to disease conditions, while also managing a multitude of complex, interrelated decision constraints, including their own risk perceptions, and limited, uncertain, confounding information, in the midst of a pandemic with major safety consequences. To identify the constraints nurses face when making triaging decisions, and to model the strategies they use when triaging, the project studies triage nurses from two large academic medical centers. The project retrospectively analyzes triage phone calls for patient risk screening, prospectively records screens nurses use as information sources, and interviews nurses about their constraints, strategies, risk perception and cognitive workload. The project maps a nurse’s patient-specific decision-making trajectories to reveal their constraints and how they managed them. Cumulatively, the data is expected to reveal generalizable strategies for triage decisions during catastrophic events.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.