Inadequate baseline and 6-month retention of the Emergency Severity Index by experienced Emergency Department registered nurses [abstract] Abstract uri icon


  • Background: The use of the Emergency Severity Index (ESI) for clinical evaluation of emergency patients in the United States is widespread. Although initially developed for clinical triaging of individual patients, ESI scores are now used for multiple purposes (e.g., research using aggregate patient data, operational assessments of emergency departments [EDs]). To date, there is no study examining previously trained experienced ED nursing staff knowledge of ESI, or their retention ability after retraining.
    Objectives: To evaluate the baseline knowledge and the ability of ED RNs to retain knowledge of ESI at 6-months after retraining session.
    Methods: With IRB approval, previously ESI-trained RNs with current ED experience completed a 30-item pre-test on the knowledge of ESI. All participants then completed a 2-hour AV session with the educational material published by the Agency for Healthcare Research and Quality (AHRQ) followed by a second 30-item post-test. Six months after the retraining session, the nurses completed an online 30-item retention test. All tests consisted of the questions provided in the AHRQ material. The nurses continued to work in EDs using ESI during that time period. Comparisons were conducted with pre-, post-, and 6-month test results using repeated measures ANOVA, controlling for age and years of experience.
    Results: Mean pre-test score for the 27 participants was 65% correct (95% CI 60.23, 70.44), which was significantly lower than the mean post-test score of 80% (95% CI 77.65, 83.17) (p < 0.001). The mean post-test retention score was 65% (95% CI 60.05, 70.10), which was not different from the pre-test score for this cohort (p = 0.19). These results were consistent when controlling for age and years of experience of the provider.
    Conclusion: Emergency department RNs with previous ESI training and clinical experience had inadequate baseline performance (pre-test), especially when compared to their post-retraining score. RNs also showed a significant decline on 6-month retention test, essentially returning to their baseline performance. Our results suggest the current ED RN’s knowledge of ESI may be inadequate but can improve with retraining. Non-sustained and suboptimal performance of ED RNs at 6 months after retraining indicates a need for regular and frequent review of the ESI material.

publication date

  • 2011