Newly Developed Simulation Provides Creative Triage Training

Through their innovative “Triage Tabletop” simulation, Brandi Snow, MSN, BSN, AG-ACNP, and Laura Liggett, DNP, AGACNP-BC, FNP-C, set out to better prepare nursing students for clinical practice—and to do so in a way that is easily replicable and requires very little resources.

Brandi Snow, now the Director of Advanced Practice and Nutrition Services at Duke Regional Hospital, earned her Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) master’s degree at Duke University School of Nursing. Snow’s coauthor, Laura Liggett, earned her DNP at Clarion University and is now also an Acute Care Nurse Practitioner in the Duke Health system. 

Liggett and Snow met while participating in on-campus intensives (OCIs) at the School of Nursing and precepting for some of the Acute Care Nurse Practitioner students. They said that Dr. Callie Tennyson, who now directs the AGACNP program, invited them to create a simulation that exposes students to the triaging and problem-solving demands that they might encounter in hospital settings.

“This simulation and scholarship are evidence of the creativity, resourcefulness, and passion of the faculty and staff at DUSON,” said Dr. Tennyson.

While they worked together on the simulation, Snow said that Triage Tabletop was Liggett’s “brainchild.” 

“Triage Tabletop is a low-fidelity simulation based off of my experience precepting for students as well as my experience transitioning into practice,” said Liggett. “This simulation was what I felt was needed for the students to be clinically ready.”

“It requires only limited resources, so it can be used anywhere and in any venue, whether that's in person like we did on campus or in a Zoom session,” Liggett continued. “And it's really educating the person on how to prioritize care, but also navigating being a provider in a healthcare system.”

Using real patient situations, Snow and Liggett divided simulation participants into groups of four or five, providing them with basic objectives along with a list of eight patients and their diagnoses. They asked each group to discuss the order in which they would see the patients, providing rationales for their clinical decisions, before coming together as a large group to debrief.

“It was really interesting in the debrief to see how the students used their different experiences and education,” said Snow. “For example, students with an emergency department background thought about throughput, so they prioritized moving people out of the emergency department to be admitted elsewhere or getting them discharged.” 

“Meanwhile, students with more of a critical care background wanted to see the sickest patient first,” Snow continued. “So, it was really interesting how they were able to learn from each other.”

Based on surveys they collected and small group discussions, Snow and Liggett were able to rapidly improve the simulation from one semester to the next, introducing lab results and diagnostic tests to the simulation materials. They also used real pagers, paging the students with emergent issues and concerns to encourage further cognitive flexibility in their decision making. 

Liggett and Snow hope to spread awareness about the possibilities for low-resource simulations through their publication, “Triage Tabletop: Exploring Prioritization and the Dynamics of Clinical Decision-Making in Acute Care,” appearing in Nurse Educator. 

“What we're trying to do is to educate universities and schools of nursing that you don't necessarily need all these resources or a simulation center. You can still provide the students with this opportunity to have a good quality experience,” said Liggett.

“Healthcare is a team sport. You know, we all have to work together to take care of patients,” Snow added. “We hope we can make the role transition for nurses a little easier.”