Emergency Department Trends and Issues

This assignment requires an analysis of various research papers focusing on trends and issues within emergency departments. The papers explore topics such as non-medical prescription drug use, mental health diagnoses among veterans, factors driving frequent ED visits, violence against nurses, opioid misuse, and the impact of aging patients. The analysis should delve into the findings of these studies and their implications for healthcare.

Running head: CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
Critical analysis of the emergency department triage
Name of the student:
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1CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
Table of Contents
Introduction: 2
Background: 3
Methods: 4
Results: 6
Summary Assessment and Conclusion: 7
Relevance to nursing practice: 8
Reference: 10

2CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
Introduction:
One of the most dynamic sectors of a health care facility which handles by far the highest
demands is the emergency department. Along with that it has to be mentioned that the
emergency department triages often is the place where the primary care for the patient is
initiated. Hence the individual factors associated with the emergency care triage environment are
crucial to ensure absolute safety of the patent under consideration (Abuse, 2013). Now
considering the mental health practices the implicatiosn of initial triage environments are even
more imperative. The article “Implications of the emergency department triage environment on
triage practice for clients with a mental illness at triage in an Australian context” by authors
Marc Broadbent, Lorna Moxham and Trudy Dwyer, discusses the very implications that the
emergency care triage environments impact on the triage care of nurses for mental illness wards
taking the Australian context as exemplary (Broadbent, Moxham & Dwyer, 2014).
This study had been an exploratory qualitative study that has taken a ethnographic
observational design for the entire study and taken into consideration the perception of the nurses
regarding the triage environment implications and the actual impact that it imparts on the care
quality. It has to be mentioned in this context that there have been vey studies that have
dedicated attention towards the impact that health care environment imparts on the care quality
and the overall experience of the patents while in the facility. Moreover, taking the triage
environment and the implications of the same onto the care quality that the patients receive is an
appreciable effort from the authors’ part. However, this assignment will attempt to critically
evaluate the article thoroughly taking each and every factor associated with the concept into
consideration (Asarnow et al., 2011).

3CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
Background:
The study explains beautifully the importance of emergency department care in Australia in
the context of mental health, as the mentally ill patient seeking acute mental health services in
Australian health care industry receive line of care or medical attention in the emergency care
department. It has to be mentioned in this context that there have been measures to improve the
Australian emergency department scenario for a long time, however the authors highlight the key
issue in this sector to be the fact the exact number of patients presented in the ED is unknown top
the triage nurses, which poses a significant challenge to the ED triage nurses (Broadbent,
Moxham & Dwyer, 2014). Hence this research study attempted to explore the entire triage
practice environment of the emergency department and discover all the different issues
associated with the professional clinical practice in the mental health care facility ED. However
the study emphasises on the patent assessment and patient management techniques incorporated
In the ED triage with the concept of a safer and more compassionate environment in the ED can
facilitate more improved therapeutic relationship between the nurses and the mentally ill
patients.
The literature review for the paper is very concise however it still includes vital data that
have been published previously in the subject. For instance, the literature review begins with the
ED guidelines applicable in the Australian health care context, explaining the dedicated areas for
assessment and stabilization of the patients. However the authors have also discussed in the
literature review the fact that in most cases the ED triage staff cannot leave the patients
unsupervised in the dedicated area where the tension around other mentally ill patients in the
most cases are taken care of by non trained staff in the waiting area (Carlier et al., 2012). The
waiting time for the mentally ill patients in the triage is extended multiple folds until a medical

4CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
practitioner is available for the patient for post ED triage, and this is the fact that creates the most
of the chaos in the ED triage; which has been beautifully highlighted in the article. The literature
review also discusses in detail the policy guidelines regarding the triage environment in the ED
and the 6 factors mandated in the policy documents, however it has to be mentioned that the
literature review failed to incorporate any reliable statistical data about the experience of the
patients in the ED room and how the chaos affects the nursing performance and triage
environment (Broadbent, Moxham & Dwyer, 2014).
The primary aim of the study as stated by the authors is to explore the challenges that arise in
the chaotic and complex environment of a ED triage room and how the nurse manage and assess
the patients in such an environment.
Methods:
The research design opted for the study by the authors is ethnographic exploratory design in
the hopes of understanding and observing the ED nurse practice and the impact of chaotic triage
room environment on the same. As ethnography is a measure that takes into account the real
world scenario of any phenomenon, observing the unique characteristics, cultural influence and
personal principles and values into the verdict. As the cultural values and principles of the
nursing staff has a significant impact on the nursing care provided and the environment, this
ethnographic approach suits the purpose of the study perfectly (Cohen et al., 2010).
The sample setting of the research study selected had been regional hospital in Australia with
a large ED with 44000 annual client separation rates, with 4.5% of the patent population being
mentally ill. Hence it can be stated that the large sample design will be extremely beneficial in
generating a diverse and relevant verdict regarding the research question asked in the study. The

5CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
study participants were 45 ED triage nurses with the adequate qualifications to conduct nursing
triage, out of which one emergency nurse carried out morning shift triage, two in the afternoon
shift and one for the night shift triage (Broadbent, Moxham & Dwyer, 2014).
The procedure of the research incorporated data collection method by participant
observation, semi structured interviews both formal and informal that was conducted specifically
with the triage nurses, and document exploration. Now it has to be mentioned in this context that
the participant observation data collection techniques emphasizes on observing the candidates in
their own professional environment with excruciating detail so that, professional, personal and
cultural values of that individual is reflected in equity in the observation. Now participant
observation technique is imperative in an ethnographic research design hence the data collected
method was also apt for the research study.
The data analysis approach taken by the study was comprehensive and systematic which can
be considered eclectic data analysis procedure that constantly and consistently compares the data
from the interviews and extensive notes taken by the ethnographer. These inductive systematic
analysis techniques will expertly analyse each and every element of the entire research pattern in
acute detail which is extremely suitable for the research design and is even congruent
(Broadbent, Moxham & Dwyer, 2014).
Now considering the ethics and trustworthiness of the research being conducted in the article,
four pillars of research ethics were taken into consideration, that are respect, research merit and
integrity, justice and beneficence. The study participants were well informed and consented
before they participated in the research study and along with that it also needs to be mentioned
that the participants were given the complete liberty to abandon the research o decline to further

6CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
participate at any point in the entire duration of the research study. Hence the ethical stand and
trustworthiness of the study needs to be appreciated (Lowthian et al., 2010).
Results:
The result section of the article is compartmentalized into different clear segments; the first
section speaks of the triage environment in acute detail. The authors have described the triage
environment of the ED room explicitly and the inclusion of noise creep in the triage environment
of the ED highlights the extensive research conducted in the research study. Now noise creep is a
phenomenon that restricts the ability to have uninterrupted private conversations with the
patients which is a significant part of establishing a mutually respectful therapeutic relationship
with the patient (Pich et al., 2010). Along with that the authors have also included the presence
of too bright lights and stark nature of the triage room environment which can be discomforting
and even provoking for severely mentally ill individuals. However authors also inform that the
nurses in the ED triage are cognisant of the environmental impact on the triage performance
however their level of understanding is not shared in the findings section. However the most
probable contributing factor to the ignorance of the nursing staff towards the chaotic ED
environment is explained as rapid client assessment and extreme influx of patients (Seal et al.,
2012).
The second section of the result includes triage assessment which declares in the very
beginning that the practice environment has a direct impact on the ED triage performance of the
nurse. The authors here illustrate the findings with the help of the recorded conversation notes of
the participants which increases the relevance and authenticity of the research significantly. The
open public nature of the ED triage room is reflected as a major concern in the findings which is

7CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
relevant as it opposes one of the key guidelines in Australian mental health assessment policy,
which requires the triage assessment space to be a dedicated enclosed area. The authors have
stated that the ED nurses feel strongly about the lack of privacy in the ED triage room and they
do not blame the waiting room full of patients only for this phenomenon rather they indicated it
to be an illustration of the general lack of privacy in ED, which reveals a severe concern
(Takahashi et al., 2012).
The results also explain how the lack of privacy in the ED contributes to the quality of care
and assessment provided to the patient and restricts the confidentiality being maintained in the
ED triage room. And the client management section of the results explains how the impact of the
chaotic triage room and lack of privacy contribute to the entire phenomenon of disrupted client
management. And the findings of this research study points relevantly to the lack of privacy and
calm to be the main contributing factors behind the compromised client management. Hence it
has to be mentioned that the results interpreted and described authentic and insightful meaning of
the data collected in the research study (Taylor & Rew, 2011).
Summary Assessment and Conclusion:
In the discussion section of the research article the office illustrate importance of privacy
and security in maintaining a safe and therapeutic relationship between the patient and the nurse
in order to facilitate better assessment and client management in the mentally ill health sector.
Tortoise discuss that the position of a private and saves Healthcare environment is a mandatory
requirement in case of nursing practice that involves mentally unstable patients, as chaotic and
uncontrollable in almonds can provoke the patients further and contribute to deterioration of their
condition. The authors of also discussed nurses to be the mediators of therapeutic landscape that

8CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
contribute to the Restoration and rejuvenation after health and well-being of a mentally unstable
patients, hence the desired are finding a safe and private environment for assessment incline
management of the patients by the ED triage nurses, indicate at the influential need for safe and
comfortable private environment in the emergency department triage for mentally ill patients.
However main purpose behind the research study had been to explode the challenges associated
with effective triage assessment and client management, and one of the greatest challenges that
were discovered was a lack of privacy, chaotic environment, and excessive workload in the ED
triage area (Weinick, Burns & Mehrotra, 2010). And it is imperative for the vulnerable and
fragile mentally ill clients, where the lack of privacy and safety in the chemical environment
contributes to further deterioration of the patients conditions. Last year and concluded know that
has to be mentioned that they study has taken into consideration a very novel concept that has
been neglected in the previous studies carried out on the same topic. Is ethnographic research
highlighted the individual participant perceptions regarding practice environment and the
challenges associated with it in the mental health sector, and it can be hope that this study will
provide a fertile ground for further research to be carried out that well characterized is key issues
in the practice environment of ED triage and attempt to construct strategies that will address
these challenges (Broadbent, Moxham & Dwyer, 2014).
Relevance to nursing practice:
In conclusion, elaborating the relevance of this study to the nursing practice and its
improvement is imperative. It has to be mentioned in this context that nursing practice is
associated with the values and principles along with the competence of the nursing workforce.
And these key factors of performance are influenced by both patient interaction and demands and
clinical environment. Thos research study has attempted to address one of the key influencing

9CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
factors and very effectively discovered the key challenges that the ED triage rooms of mental
health facilities face. This study will be extremely helpful in improving the triage environment
and incorporating privacy and patient safety into the clinical environment. Hence this research
study addresses both patient values and care context of mental health services. And this study
will serve to highlight all the key issues that influence both assessment and client management in
the mental health ED which is crucial to performance improvement for ED nursing workforce
(Broadbent, Moxham & Dwyer, 2014).

10CRITICAL ANALYSIS OF THE EMERGENCY DEPARTMENT TRIAGE
Reference:
Abuse, S. (2013). Mental Health Services Administration, Drug Abuse Warning Network, 2011:
National Estimates of Drug-Related Emergency Department Visits. HHS publication no.
(SMA), 13,4760.
Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., ... & Tang,
L. (2011). An emergency department intervention for linking pediatric suicidal patients to
follow-up mental health treatment. Psychiatric services, 62(11), 1303-1309.
Braden, J. B., Russo, J., Fan, M. Y., Edlund, M. J., Martin, B. C., DeVries, A., & Sullivan, M. D.
(2010). Emergency department visits among recipients of chronic opioid therapy. Archives
of internal medicine, 170(16), 1425-1432.
Broadbent, M., Moxham, L., & Dwyer, T. (2014). Implications of the emergency department
triage environment on triage practice for clients with a mental illness at triage in an
Australian context. Australasian Emergency Nursing Journal, 17(1), 23-29.
Carlier, I. V., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J., & Zitman, F.
G. (2012). Routine outcome monitoring and feedback on physical or mental health status:
evidence and theory. Journal of Evaluation in Clinical Practice, 18(1), 104-110.
Centers for Disease Control and Prevention. (2010). Emergency department visits involving
nonmedical use of selected prescription drugs-United States, 2004-2008. MMWR: Morbidity
and mortality weekly report, 59(23), 705-709.

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Cohen, B. E., Gima, K., Bertenthal, D., Kim, S., Marmar, C. R., & Seal, K. H. (2010). Mental
health diagnoses and utilization of VA non-mental health medical services among returning
Iraq and Afghanistan veterans. Journal of general internal medicine, 25(1), 18-24.
Doran, K. M., Raven, M. C., & Rosenheck, R. A. (2013). What drives frequent emergency
department use in an integrated health system? National data from the Veterans Health
Administration. Annals of Emergency Medicine, 62(2), 151-159.
Lowthian, J. A., Curtis, A. J., Cameron, P. A., Stoelwinder, J. U., Cooke, M. W., & McNeil, J. J.
(2010). Systematic review of trends in emergency department attendances: an Australian
perspective. Emergency Medicine Journal, emj-2010.
Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2010). Patient‐related violence against
emergency department nurses. Nursing & health sciences, 12(2), 268-274.
Seal, K. H., Shi, Y., Cohen, G., Cohen, B. E., Maguen, S., Krebs, E. E., & Neylan, T. C. (2012).
Association of mental health disorders with prescription opioids and high-risk opioid use in
US veterans of Iraq and Afghanistan. Jama, 307(9), 940-947.
Slade, E. P., Dixon, L. B., & Semmel, S. (2010). Trends in the duration of emergency
department visits, 2001–2006. Psychiatric Services, 61(9), 878-884.
Takahashi, P. Y., Pecina, J. L., Upatising, B., Chaudhry, R., Shah, N. D., Van Houten, H., ... &
Hanson, G. J. (2012). A randomized controlled trial of telemonitoring in older adults with
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of internal medicine, 172(10), 773-779.
Taylor, J. L., & Rew, L. (2011). A systematic review of the literature: workplace violence in the
emergency department. Journal of clinical nursing, 20(7‐8), 1072-1085.

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Weinick, R. M., Burns, R. M., & Mehrotra, A. (2010). Many emergency department visits could
be managed at urgent care centers and retail clinics. Health Affairs, 29(9), 1630-1636.
Welch, S. J., Asplin, B. R., Stone-Griffith, S., Davidson, S. J., Augustine, J., Schuur, J., &
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definitions: results of the second performance measures and benchmarking summit. Annals
of emergency medicine, 58(1), 33-40.