Round-off decision-making: Why do triage nurses assign STEMI patients with an average priority?

Mor Saban, Lev Zaretsky, Heli Patito, Rabia Salama, Aziz Darawsha

Research output: Contribution to journalArticlepeer-review


Patients with suspected ST elevation myocardial infarction should be classified with a high-priority triage level in the Emergency Department. Accurate triage can reduce mortality and morbidity in ST elevation myocardial infarction patients. Yet, half of these patients were given a low-priority score, especially the average classification (P3 on a P1–P5 scale). Aim: To identify and clarify significant factors in the triage process that result in P3 assignment for patients with ST Elevation Myocardial Infraction diagnosis. Methods: A retrospective-archive study was conducted at a tertiary hospital from January 2015 to November 2017. We collected and measured patients’ characteristics, Emergency Department setting variables, and hospitalization characteristics. Data files were extracted from the electronic database (n = 140). Results: The results show several key factors that affect the decision to assign P3 in the triage process. Analysis of patients’ sociodemographic characteristics show that being female (OR = 1.96, P = .05) or having Arab ethnicity (OR = 2.19, P = .01) is significant to P3 assignment. Number of cardiac events (P = .02) is the only noteworthy cardiologic comorbidity of all that were reviewed. A connection was observed between a patient being classified as average urgency and poor treatment outcomes, namely for the variables time to physician, total time in the Emergency Department, door-to-balloon time, and in-hospital mortality. Conclusion: Average classification demonstrates the extreme risk involved in the triage process. Our research provides considerable data to identify factors that affect the decision to classify patients as P3.

Original languageEnglish
Pages (from-to)34-39
Number of pages6
JournalInternational Emergency Nursing
StatePublished - Mar 2019
Externally publishedYes


  • Chest Pain
  • Door-To-Balloon Time
  • Emergency department
  • ST elevation myocardial infarction
  • Triage


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