Bridging the Experience Gap: An ED Escalation Guide

Introduction: Many new graduate nurses are hired to work in Emergency Departments (ED’s). This study evaluated whether the introduction of an ED Escalation Guide (EDEG) based on similar medical-surgical early warning systems (EWS) would be valuable as an EWS for emergency nurses. The EDEG is a chart providing ED-appropriate parameters to prioritize vital signs and key indicators of severity of illness, and a listing of critical symptoms. Design, Setting, Sample: The study was done in an 80 bed adult ED in a non-profit community hospital. This descriptive study consisted of a comparative review of quizzes given to ED nurses with varying levels of experience and clinical expertise, with and without the use of the EDEG. The quizzes contained ten brief scenarios that require assessment of patient symptoms, and classification into one of three priorities based on their need for ED physician intervention. A total of 147 quizzes were returned by ED RN’s. Methods: Two similar scenario quizzes, the second one including availability of the EDEG, were given to ED RN’s one week apart. Each quiz also requested demographic data about years of ED experience & ED clinical expertise. Scores were compared based on those demographics. Results: Scores on the scenario quizzes ranged from 40% to 100%. Nurses with more experience had higher scores. RN’s with greater than1 year of ED experience showed minimal differences in scores with and without availability of the EDEG, apparently relying on their own judgment. RN’s with less than 1 year of ED experience showed a 25% improvement in scenario scores with use of the EDEG. Implications: RN’s with less than 1 year of ED experience might not recognize/ report critical symptoms without a guide. The EDEG helps increase the confidence of novice emergency nurses in their assessments by providing specific parameters for determining clinical deterioration