The accuracy of triage classification using Emergency Severity Index

Area of Science:

• Emergency Medicine
• Nursing Research
• Healthcare Quality Improvement

Background:

• Accurate emergency triage is critical for patient care and resource allocation in emergency departments (EDs).
• Assessing the accuracy of triage performed by ED nurses is essential for identifying areas of improvement.

Purpose of the Study:

• To evaluate the accuracy of triage acuity levels assigned by ED nurses.
• To identify factors that may influence triage accuracy.

Main Methods:

• An observational study involving a chart review of 100 patients across three EDs.
• Comparison of nurses' initial triage acuity with the Emergency Severity Index (ESI) Version 4 handbook.
• Assessment of inter-rater reliability using Cohen's kappa coefficient.

Main Results:

• Overall triage accuracy was 67%, with moderate inter-rater reliability (Cohen's kappa = 0.437).
• Under-triage occurred in 25% and over-triage in 8% of cases.
• Triage accuracy varied significantly by patient sex, complaint type, shift, and mode of arrival.

Conclusions:

• Triage inaccuracy may stem from nursing- and patient-specific factors.
• Further investigation into factors affecting triage accuracy is warranted to improve patient outcomes.