Daily triage audit can improve nurses' triage stratification: A pre-post study.

Area of Science:

• Emergency Medicine
• Healthcare Quality Improvement
• Nursing Practice

Background:

• Triage systems are critical for prioritizing patients in emergency departments.
• Ensuring accuracy and consistency in triage is essential for patient safety and efficient care delivery.
• Previous methods for assessing triage accuracy and inter-rater reliability may have limitations.

Purpose of the Study:

• To evaluate the impact of daily auditing on the error rate of the triage system.
• To assess the change in agreement between physicians and nurses regarding triage priority levels post-auditing.
• To analyze shifts in error-related variables before and after implementing daily auditing.

Main Methods:

• A quasi-experimental study with a pre-post design was conducted over two years in an emergency department.
• Triage accuracy and error rates were compared between pre- and post-intervention periods.
• Logistic regression and Cohen's Kappa were used to analyze errors and inter-rater agreement.

Main Results:

• The triage error rate decreased substantially from 23.3% in the pre-intervention period to 9.7% post-intervention.
• Inter-rater agreement, measured by Cohen's Kappa, significantly improved from 0.447 to 0.881.
• The study involved 904 patients pre-intervention and 869 post-intervention.

Conclusions:

• Daily auditing is an effective clinical procedure for enhancing nurses' application of the triage system.
• Implementation of daily auditing led to a significant reduction in triage errors and improved concordance between nurse and physician assessments.
• Maintaining high-quality triage standards through daily auditing demonstrably improves patient safety and overall emergency department performance.