Education and Training Interventions to Improve Emergency Department Triage Accuracy and Decision-Making Among Nurses: A Systematic Review
DOI:
https://doi.org/10.31674/mjn.2026.v18i01.016Abstract
Background: Accurate triage is a critical component of timely emergency care, but there is considerable variation in acuity assignment and mis-triage across Emergency Department (ED) settings. Under-triage has important patient safety implications such as delayed care and unnecessary deterioration. Education and training are common methods for improving triage decision-making, but the most effective methods are unknown. Objectives: To synthesize evidence on education and training interventions used to improve triage accuracy and decision-making among emergency nurses across multiple five-level triage systems, using the Canadian Triage and Acuity Scale (CTAS) as the primary reference framework. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search was conducted in the databases Medline/PubMed, Scopus, and Google Scholar up to 16 March 2026. Studies included an assessed education, training, or decision-support intervention targeting triage for emergency nurses. Outcomes were measured as acuity assignment accuracy, under-/over-triage, inter-reliability and decision-making skills. Narrative synthesis was used for the findings because of the heterogeneity in study designs. Results: Seventeen studies met inclusion criteria, spanning CTAS, Emergency Severity Index (ESI), Korean Triage and Acuity Scale (KTAS), Australasian Triage Scale (ATS), and South African Triage Scale (SATS) contexts. Interventions comprised refresher education, mobile and gamified applications, e-learning, simulation, problem-based learning, and electronic decision support. Most studies reported positive findings regarding triage performance post-intervention, but effect sizes varied across systems and settings. Training effects may diminish over time without reinforcement, and barriers to implementation included workload, fatigue, and organizational factors. Conclusion: Structured, interactive, and reinforced methods, including technology-facilitated decision support where available, may contribute to triage competency maintenance and patient safety. However, effects are heterogeneous across triage systems and settings, and findings from non-CTAS systems should not be directly generalized to CTAS.
Keywords:
Canadian Triage and Acuity Scale (CTAS), Decision-Making, Education, Emergency Nursing, Systematic Review, Training, Triage, Triage AccuracyDownloads
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