Five-level triage system more effective than three-level in tertiary emergency department

Area of Science:

• Emergency Medicine
• Healthcare Systems Analysis
• Nursing Practice

Background:

• Emergency departments (EDs) often utilize triage systems to prioritize patient care.
• Traditional 3-level (3L) triage systems may have limitations in accurately assessing patient acuity.
• The implementation of a 5-level (5L) triage system offers a potential improvement in ED patient management.

Purpose of the Study:

• To compare the reliability and validity of a 3L triage system against a novel 5L triage system.
• To evaluate the impact of nursing experience on the reliability of triage decisions.
• To assess the safety and discriminatory power of different triage levels.

Main Methods:

• A comparative study was conducted in a tertiary ED, assessing triage reliability using weighted kappa.
• The 5L system was implemented, and reliability was remeasured.
• Validity was assessed by comparing triage levels with case mix, sensitivity, specificity, physician billing codes, and nursing resource intensity.

Main Results:

• The 5L system showed improved reliability (weighted kappa 0.68) compared to the 3L system (weighted kappa 0.53).
• Sensitivity increased from 58% (3L) to 68% (5L), and specificity from 83% (3L) to 91% (5L).
• Under-triage rates decreased significantly from 28% (3L) to 12% (5L), with less experienced nurses benefiting most.

Conclusions:

• The 5L triage system offers superior safety, discrimination, reliability, sensitivity, and specificity over the 3L system.
• The 5L system is a more effective tool for emergency department patient prioritization.
• Nursing experience impacts triage reliability, with the 5L system mitigating some of these effects.