Triage nurses decision-making processes: A qualitative systematic review

Hugh Gorick, Toby O. Smith, Marie Mcgee, Gemma Wilson, Emma Williams, Jaimik Patel, Anna Zonato, Wilfred Ayodele, Sabina Shams, Luca Di Battista

Research output: Contribution to conferenceAbstractpeer-review



Understanding how nurses make acuity assessments on initial presentation to emergency departments is important. It affects how rapidly a patient is seen by a doctor and subsequent time to receive treatment. Whilst several literature reviews have previously explored this area, no qualitative systematic review has been published.


This qualitative systematic review aimed to understand the decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation.


A systematic search was conducted of Medline, CINAHL and academic search complete. Papers were double screened with reviewers blinded to each other’s decisions. Critical Appraisal Skills Programme qualitative checklists were used to appraise the methodological quality of included studies. Themes were created using thematic synthesis. GRADE-CERQual was used to evaluate certainty of evidence in the findings.


28 studies were included in the review. Data analysis resulted in the identification of three superordinate themes and seven subordinate themes. GRADE-CERQual analysis indicated nine themes presented with high certainty of evidence, and one with moderate certainty.


Nurses assess patients using holistic reasoning, gathering data which is then interpreted through a mix of clinical reasoning and intuition. The decision-making process is influenced by the situational awareness of the nurses, with strong impact from environmental factors. These processes are supported by the nurse’s knowledge and experience, and training for these is vital, although considered lacking.


The findings present a new perspective on how nurses make decisions about the acuity of patients in the emergency department. From this, we can offer suggestions on improvements to the triage system that work with the nurses’ decision-making processes, increasing acceptability and effectiveness, and resulting in improved patient outcomes.
Original languageEnglish
Publication statusPublished - 12 Nov 2023
EventEmergency Nursing and Trauma Care - Gothenberg, Sweden
Duration: 9 Nov 202311 Nov 2023
Conference number: 4th


ConferenceEmergency Nursing and Trauma Care
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