Development of physiological discriminators for the Australasian Triage Scale

The Consistency of Triage in Victoria's Emergency Departments Project (2001), funded by the Victorian Department of Human Services, aimed to improve the consistency of application of the Australasian (National) Triage Scale (ATS). One of the major objectives of the project was the development of an education strategy to promote a consistent approach to triage education, leading to the development of the Adult Physiological Discriminators (APDs) for the ATS and Paediatric Physiological Discriminators (PPDs) for the ATS. The guidelines and physiological discriminators were developed in consultation with the Emergency Nurses' Association of Victoria (ENA Vic.) and clinical nurse educators, lecturers, nurse unit managers and clinicians from a wide variety of Emergency Departments (EDs) across Victoria. Numerous studies have identified varying degrees of inconsistency in the application of the ATS. A number of factors associated with inconsistency in the application of the ATS have also been alluded to in the literature. These range from the wide variation in the experiential and educational requirements of Victorian triage nurses to the specific clinical characteristics of the patient identified by the triage nurse. However, a consistent approach to triage education and uniform triage guidelines has been repeatedly identified as a key factor in improving the consistency of application of the ATS. Physiological data demonstrates the highest degree of objectivity and consistency and research has shown that physiological observations are useful and measurable indicators of clinical urgency and patient safety. This paper will discuss the development of these discriminators as part of the educational strategy including a critique of other approaches to triage decision-making and a review of the consultative processes used to facilitate consensus amongst triage nurses, ED Nurse Managers and ED Nurse Educators. The physiological discriminators developed by this project are also presented.