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How reliable is emergency department triage?
C M Fernandes1, R Wuerz, S Clark
1University of British Columbia, Vancouver, Canada, Harvard Medical School, Boston, MA, USA. Multicentre Operations Research Group. cfernand@unixg.ubc.ca
Annals of Emergency Medicine
|July 29, 1999
Summary
This study found general agreement among healthcare professionals using an emergency department triage system. Further research is needed to identify specific areas where assessment variations occur.
Area of Science:
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- Effective emergency department (ED) triage is crucial for patient outcomes.
- Assessing the reliability of triage systems is essential for quality assurance.
Purpose of the Study:
- To evaluate the interrater and intrarater agreement of an emergency department triage system.
- To identify consistency in severity ratings and resource allocation decisions.
Main Methods:
- A 2-phase experimental study involved nurses and physicians assessing standardized patient scenarios.
- Participants used a 5-tier severity rating system and estimated admission probability, evaluation time, and need for monitored beds/diagnostic services.
- Interrater agreement was measured using a coefficient of agreement.
Main Results:
- Intrarater agreement for nurses rating triage severity was substantial (.757).
- Interrater agreement between nurses and physicians was substantial for monitoring needs and moderate to substantial for other assessments.
- Participant completion rates were lower than anticipated.
Conclusions:
- General agreement exists in interrater assessments within the emergency department triage classification.
- Areas of variation in triage assessment require further investigation to enhance system reliability.