Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter...

Area of Science:

• Emergency Medicine
• Nursing Practice
• Clinical Triage

Background:

• Standardized triage systems have seen minimal updates despite significant advancements in nurses' skills and knowledge.
• Existing triage protocols may not fully leverage the expertise of modern nursing professionals.

Purpose of the Study:

• To compare the effectiveness of nurses' clinical expertise against standardized triage systems in simulated emergency scenarios.
• To evaluate which method better predicts critical patient outcomes.

Main Methods:

• A multicenter simulated observational study involving 77 triage nurses across four Italian emergency departments.
• Nurses evaluated 30 real-world clinical vignettes, assigning triage codes using both the Manchester Triage System (MTS) and their clinical expertise.
• Outcomes assessed included agreement with MTS, prediction of death within 72 hours, need for hospitalization, and need for life-saving interventions.

Main Results:

• Clinical expertise showed better prediction for patient death within 72 hours compared to the MTS.
• The MTS demonstrated lower performance than clinical expertise in predicting the need for life-saving interventions.
• Agreement between MTS and clinical expertise triage codes was moderate (Cohen's kappa = 0.576), with higher variability in expertise-based assignments.

Conclusions:

• Nurses' clinical expertise offers superior prediction of patient outcomes in simulated settings, highlighting a need to integrate advanced nursing skills into triage systems.
• While clinical expertise improves outcome prediction, standardized systems remain crucial for reducing variability and ensuring consistent patient classification.
• Recommendations include updating current triage protocols to better reflect and utilize the advanced capabilities of nurses.