Document Type

DNP - Open Access

Award Date


Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Jo. A. Voss

Second Advisor

Nicole Gibson


Emergency Severity Index (ESI), ESI algorithm, ESI annual competency assessment, Triage trained registered nurses (RNs)


Introduction: In order to accurately assign an Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage area, it is essential triage nurses remain competent in the ESI triage tool. In addition, effective use of the ESI triage tool is critical in preventing patients from being mistriaged.
Objective: The purpose of this quality improvement project was to determine the effect of an ESI annual competency assessment in an ED for triage trained registered nurses (RNs).
Methods: Triage trained RNs completed an ESI competency assessment composed of 25 patient scenarios in competency assessment A, and 10 patient scenarios (if competency assessment B was needed). The patient scenarios utilized were previously created by the Agency for Healthcare Research Quality (AHRQ). Pre- and post- implementation data was collected via retrospective chart reviews and interpreted with application of the ESI algorithm, comparing the assigned ESI level that was performed by the triage trained RN against the calculated one using the algorithm to determine if the initial assigned ESI level was accurate.
Results: A retrospective chart review (RCR) of 150 charts was conducted; 75 pre- and 75 post- intervention implementation data were analyzed to determine the ESI accuracy by triage trained RNs. Pre and post data were represented by categories of correct triage and mistriage (separated into undertriage and overtriage). A chi-square test was the statistical test used for the data analysis of the RCR and a p-value of 0.8535 was attained, concluding that between the pre and post data, there was no statistically significant difference in mistriage.
Discussion: The implementation of an ESI annual competency assessment aligns well with an emerging theme in the literature that ED nurses should be provided with ongoing education and frequent methods of reinforcing knowledge and implementation of ESI triaging.

Library of Congress Subject Headings

Triage (Medicine)
Emergency nursing.
Emergency medical services.
Emergency management.

Number of Pages



South Dakota State University


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