Annotated Bibliography

Please use the articles provided to create annotated bibliographies. Summarize the main points of the article : purpose, methods, results, strengths and weaknesses. I have also attached the table format the information should be presented in.

The bibliography is discussing my DNP topic. I will attach the background information to my project as well.

My Project Background Information Below

Title : Enhancing Medical Assistant Triage Confidence Through Implementation of the Emergency Severity Index (ESI) in a Walk-In Family Practice Setting

Background/Problem:

In a private walk-in family practice clinic, the absence of a standardized triage process leads to variability in patient prioritization and reduced staff confidence in triage decision-making, which may impact workflow efficiency and patient safety. The unstandardized triage process utilized by nursing staff (MAs) has resulted in an average under-triage rate of 25% for patients presenting with non-obvious, high-acuity complaints over the last quarter. Baseline information gathered through staff feedback and workflow observations indicates that personnel frequently report uncertainty when prioritizing patients, particularly when multiple patients present simultaneously or when symptoms are unclear.

PICO(T) Question:

In Medical Assistants (MA) responsible for initial patient triage in a private walk-in family practice clinic (P), will the implementation of a standardized triage tool (ESI-Emergency Severity Index) (I) compared to the current triage process (C) impact MA self-confidence in triage decision-making (O) within a 12-week implementation period (T)?

Purpose/Aim:

The purpose of this quality improvement project is to evaluate whether implementation of a standardized triage tool, the Emergency Severity Index (ESI), improves Medical Assistant self-confidence in triage decision-making compared to the current triage process in a private walk-in family practice clinic over a 12-week implementation period.

Evidence Summary:

Current evidence supports the use of standardized triage tools and competency-based education to improve clinical decision-making, consistency, and staff confidence in triage environments. Standardized triage frameworks such as the Emergency Severity Index (ESI) provide structured criteria that reduce variability in patient prioritization and support safer clinical judgment. In addition, studies have demonstrated that competency-based education, including case-based learning and simulation, significantly improves perceived competency and self-efficacy among healthcare personnel responsible for triage (Kavakli et al., 2024). National practice guidance also recommends structured triage education and standardized tools as essential components of safe and effective triage systems (Emergency Nurses Association [ENA], 2023).

Methods:

Using a Plan-Do-Study-Act (PDSA) quality improvement framework, a standardized triage tool and competency-based education program will be implemented for licensed and unlicensed personnel responsible for triage at a private walk-in family practice clinic. Data will be collected through pre- and post-intervention self-efficacy surveys and staff feedback. The aim of this quality improvement project is to improve MA self-confidence in triage decision-making by at least 20%, as measured by a pre- and post-intervention self-confidence survey (The Triage Decision-Making Survey- TDMI), within a 12-week implementation period in a private walk-in family practice clinic.