Measuring Workflow Interface Misalignment in Emergency Department Triage

ED triage is increasingly EHR-mediated, yet little is known about how workflow–interface alignment relates to acuity assignment, workload, and usability. This feasibility study examined 18 ED triage encounters involving two experienced triage RNs. Documentation task-event sequences were recorded and used to compute the Workflow Alignment Index (WAI), which compared observed documentation order with the EHR triage form’s left-to-right element order. Emergency Severity Index (ESI) assignment accuracy was determined by retrospective two-member expert panel consensus, and nurses completed NASA-TLX and System Usability Scale measures. Across 392 documentation task-events, 15 task returns occurred, clustering in Reason for Visit and Past Medical History. Mean WAI was 0.784 ( SD = 0.075). Nurse-assigned ESI matched expert consensus in 14 encounters (77.8%), with three under-triaged and one over-triaged case. WAI was associated with documented ESI level. WAI was feasible and sensitive to variation in triage documentation behavior, warranting validation in larger studies.