Emergency department nurses’ self-reported triage decision-making abilities and associated factors: a cross-sectional study in three tertiary hospitals in Sichuan, China

BACKGROUND: This study aimed to investigate emergency department (ED) nurses' self-reported triage decision-making abilities and the associated factors, providing evidence for the development of a standardized triage training system. METHODS: Convenience sampling was adopted. An online questionnaire survey was conducted among 549 ED nurses from three tertiary hospitals in Sichuan, China from May 6 to May 17, 2025. The survey covered general information about the hospitals, respondents' demographic characteristics, and the Chinese version of the Triage Decision-Making Inventory (TDMI). RESULTS: The ED nurses' mean TDMI score was 182.54 ± 25.30, with mean item scores of 5.15 ± 0.71 for critical thinking, 5.07 ± 0.73 for cognitive behaviors, 4.78 ± 0.71 for triage experience and confidence, and 4.67 ± 0.84 for intuition. Univariate analysis showed that 13 factors-including hospital type, age, nurse level, years of work experience, and receipt of formal triage training-were associated with ED nurses' TDMI scores (all P < 0.05). Multivariate linear regression analysis revealed that specialty hospital (β = -0.132), age (β = -0.150), nurse level (β = 0.157), receipt of formal triage training (β = 0.221), familiarity with adult triage criteria (β = 0.221), and inclusion of case-based discussions in triage training (β = 0.099) were independent factors associated with TDMI scores (all P < 0.05), accounting for 18.3% of the total variation (adjusted R² = 0.183). CONCLUSIONS: The self-reported triage decision-making abilities of ED nurses in the three tertiary hospitals were at an upper-intermediate level, characterized by multidimensional imbalance and significant individual differences. Intuition may be a key area associated with improvement in self-reported triage decision-making abilities. It is recommended that a standardized triage training system be established, the application of triage criteria be strengthened, and case-based discussions be promoted during triage training. These measures are associated with improving triage decision-making among ED nurses.