Expert nurse decision-making: Telephone triage in an ophthalmic accident and emergency department

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Abstract
The accident and emergency (A&E) service at Manchester Royal Eye Hospital uses triage as a method of prioritising patients to ensure that those whose needs are urgent receive immediate attention. This service has been extended to include formalised telephone triage. This is a fairly new concept in the A&E service although it has been an informal strategy in other areas of practice for many years. The study reported here investigates the way that telephone triage decisions are made by nurse practitioners in the A&E service. Although the sample is small (n=7), interviews with the nurse practitioners reinforce previous theories about expert knowledge and decision-making (Elstein and Bordage, 1979; Tanner et al., 1987; Edwards, 1994). The study shows that the nurse practitioners use a process of hypothesis testing, a systematic and complex framework for decision-making and demonstrate a reflective process of knowing. Although the findings are grounded within this particular area of practice, they could be of use in many other areas to assist nurses in their transition to the practice of expert decision-making.