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Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.

Arian Zaboli¹, Francesco Brigo², Alessandro Cipriano³

¹Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), via A. Volta, 13°, Bolzano, Italy. zaboliarian@gmail.com.

Internal and Emergency Medicine

|August 6, 2024

Summary

Italian emergency departments (EDs) show significant variation in how nurses assign triage codes. This lack of standardization impacts patient care equity and highlights the need for consistent emergency department triage protocols.

Keywords:

Emergency Department Emergency nursing Italian triage Italy Nurse Nurse triage Triage

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Area of Science:

Emergency Medicine
Healthcare Quality
Nursing Practice

Background:

Emergency Departments (EDs) in Italy utilize diverse triage systems, leading to regional variations.
This heterogeneity raises concerns about standardized patient assessment and care delivery.

Purpose of the Study:

To evaluate the consistency and standardization of triage code assignment by nurses across different Italian EDs.
To assess inter-rater agreement and performance variations in triage code application.

Main Methods:

A multicenter observational simulation study was conducted involving four Italian hospitals.
Nurses (n=87) assigned triage codes to 30 simulated clinical cases using their respective ED triage systems.
Inter-rater agreement (kappa values) and performance metrics (sensitivity, specificity) were analyzed.

Main Results:

Significant variability was observed in triage code assignments among nurses and across hospitals.
Kappa values for inter-rater agreement ranged from 0.464 to 0.632.
Sensitivity and specificity for clinical outcomes differed considerably between participating hospitals.

Conclusions:

Triage code assignment by ED nurses exhibits a high degree of subjectivity.
The observed variability in triage practices within Italy is unacceptable for ensuring equitable patient care.
Standardization of emergency department triage systems is crucial for consistent patient management.