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Document Type

DNP - University Access Only

Award Date


Degree Name

Doctor of Nursing Practice (DNP)


Graduate Nursing

First Advisor

Jo Voss


Emergency severity index, Simulation, Triage, Acuity assignment


Introduction: Wrongful acuity assignment in triage can impact the emergency department by lengthening patient wait times before seeing a healthcare provider. This can lead to poor patient outcomes. Emergency nurses need high quality education in acuity assignment to prevent mistriage. Methods: In this practice improvement project, emergency nurses (n= 49) participated in simulation scenarios to practice using the emergency severity index triage system. Retrospective chart audits were completed by the project coordinator pre- and post-intervention to evaluate whether mistriage rates improved. Results: Emergency nurses who participated in the simulation training were primarily registered nurses with a bachelor’s degree (n= 30, 58%), and most had between 1 and 5 years of emergency department experience (n= 25, 47%). Pre-intervention, 304 patient charts were audited with a mistriage rate of 16.23%. Post-intervention, 312 charts were audited with a mistriage rate of 6.5%. The overall reduction in mistriage was 9.73%, which was statistically significant (p < 0.001). Discussion: Based on results from this practice improvement project, the emergency nurses were able to more accurately assign acuity levels to patients in triage following simulation scenarios to practice using the emergency severity index triage system. The decrease in mistriage rates also indicated that simulation was an effective method for acuity assignment training.

Library of Congress Subject Headings

Triage (Medicine)
Emergency nursing.
Hospitals -- Emergency services.
Nursing assessment.



Number of Pages



South Dakota State University


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