Mapping the evidence on implementation of clinical decision support systems in nurses' reverse triage decisions during disaster surges: A scoping review with a proposed conceptual framework.
International Emergency Nursing · 2026-11-02 · Scoping review
Abstract
BACKGROUND: Emergency and critical care nurses are increasingly required to make complex, time-sensitive decisions across intensive care unit (ICU), emergency department, prehospital, and telephone triage settings, and clinical decision support systems (CDSSs) have been proposed as a technological strategy to support this process. However, the extent to which CDSSs influence nurses' decision-making time, accuracy, and confidence remains uncertain-particularly for reverse triage during disaster surges, an area of growing importance for emergency nursing preparedness worldwide. No previous review has synthesised evidence at the intersection of CDSS technology and reverse triage. This scoping review aimed to map existing evidence on the implementation of CDSSs in nurses' decision-making across ICU and triage settings, and to identify evidence gaps concerning reverse triage during disaster surges, in order to propose a novel conceptual framework-the CDSS-RT (Clinical Decision Support System for Reverse Triage) framework. METHODS: A scoping review following JBI methodology and PRISMA-ScR was conducted and prospectively registered on the Open Science Framework (OSF registration: DOI 10.17605/OSF.IO/VKRHU). Systematic searches across MEDLINE, Scopus, CINAHL, Embase, and the Cochrane Library identified English-language studies published up to January 2026. Two reviewers independently screened records and extracted data. An evidence gap map was constructed to visualise literature distribution and gaps. RESULTS: From 4218 records, 22 studies met inclusion criteria, published between 2009 and 2026 across 13 countries. CDSSs were predominantly knowledge-based, with growing use of machine learning and artificial intelligence. CDSSs improved triage accuracy by 7-23 percentage points, reduced cognitive workload, and enhanced confidence, although alert fatigue, increased response time, and limited system integration were common barriers. The evidence gap map revealed a critical absence of studies addressing CDSSs in reverse triage during disaster surges. PROPOSED CONCEPTUAL FRAMEWORK: The CDSS-RT framework, grounded in the CDS Five Rights, CFIR, and Dual-Process Theory, integrates six components: (1) knowledge base; (2) hybrid reasoning engine; (3) user cognitive factors; (4) implementation readiness; (5) context-sensitive design; and (6) multi-level outcome metrics. CONCLUSION: Conclusion and implications: CDSSs show considerable promise for nursing decision-making in ICU and triage settings relevant to emergency nursing practice internationally. The proposed CDSS-RT framework provides a structured foundation for future CDSS-assisted reverse triage research and system design.
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Tags
Decision support tools · Implementation
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