Contents lists available at ScienceDirect International Emergency Nursing journal homepage: www.elsevier.com/locate/aaen The impact of adult trauma triage training on decision-making skills and accuracy of triage decision at emergency departments in Malaysia: A randomized control trial Siti Aishah Ghazali a,b,⁎ , Khatijah Lim Abdullah b , Foong Ming Moy c , Rashidi Ahmad d , Emni Omar Daw Hussin b a School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia b Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia c Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia d Department of Emergency Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia ARTICLEINFO Keywords: Accurate Decision Skills Triage Emergency department Registered nurses Medical ofcer assistants Triage training ABSTRACT Introduction: Patients who visit emergency departments need to undergo a precise assessment to determine their priority and accurate triage category to ensure they receive the right treatment. Aim: To identify the efect of triage training on the skills and accuracy of triage decisions for adult trauma patients. Method: Arandomizedcontrolledtrialdesignwasconductedintenemergencydepartmentofpublichospitals.A total of 143 registered nurses and medical ofcer assistants who performed triage roles were recruited for the control group (n = 74) and the intervention group (n = 69). The skill and accuracy of triage decisions were measured two weeks and four weeks after the intervention group were exposed to the intervention. Results: There was a signifcant efect on the skill of triage decision-making between the control and the in- tervention group p < 0.001, η 2 partial = 0.31. Concerning the accuracy of triage decisions, the efect was sig- nifcantly diferent between the control group and the intervention group p < 0.001, η 2 partial = 0.66 across time. Conclusion: Thetriagetrainingimprovedtheskillsoftheparticipantsandtheaccuracyoftriagedecision-making across time. 1. Introduction The emergency department (ED) is a “front door” facility that pro- vides critical care in hospitals. Patients admitted to EDs require highly time-sensitive emergency treatment and need immediate intervention [1]. Initially, a patient needs to go through a triage process by regis- tered nurses (RNs) or medical ofcer assistants (MOAs) to determine the triage category according to the severity of the patient’s condition. MOAswhoareparamedics,andRNs,bothofwhomcomplete3yearsof training, are qualifed to perform triage roles at the scene as well as in the ED. In the EDs, the triage system is divided into three categories: category 1-critical; 2-high risk; 3-non-critical [2]. In prioritizing a pa- tient’s urgency for an accurate triage category in adult patients, espe- cially for trauma, skillful RNs and MOAs are essential to ascertain the best impact of intervention on the patient’s health. Hence, knowledgeable and skillful RNs and MOAs are crucial to determine accurate triage decisions. Therefore, the current study is conducted to identify the skills and accuracy of triage decision-making for adult trauma patients in EDs and to assess the efect of triage training on the skills and accuracy of triage decision-making among RNs and MOAs in Malaysia. 2. Literature Triage is one of the core requirements for the provision of efective emergency care and has been shown to reduce patient mortality [3]. The primary aim of triage is to identify patients who can safely wait from those who cannot. The secondary aim is to ensure that patients receive safe treatment within a certain time frame [4]. Triage staf decide and allocate patient urgency for treatment and care into https://doi.org/10.1016/j.ienj.2020.100889 Received 7 April 2019; Received in revised form 28 April 2020; Accepted 12 May 2020 ⁎ Corresponding author at: School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. E-mail addresses: schah@usm.my, ai_shah66@yahoo.com (S.A. Ghazali), katlim@um.edu.my (K.L. Abdullah), moyfm@ummc.edu.my (F.M. Moy), rashidi@ummc.edu.my (R. Ahmad). International Emergency Nursing 51 (2020) 100889 1755-599X/ © 2020 Elsevier Ltd. All rights reserved. T