6.33
Hdl Handle:
http://hdl.handle.net/10755/162766
Type:
Presentation
Title:
Comparison of 3-level and 5-level Triage Acuity Systems
Abstract:
Comparison of 3-level and 5-level Triage Acuity Systems
Conference Sponsor:Emergency Nurses Association
Conference Year:2000
Author:Travers, Debbie, MSN, RN, C, CEN
P.I. Institution Name:Emergency Medicine, University of North Carolina
Contact Address:CB 7594, Chapel Hill, NC, 27599, USA
Contact Telephone:(919) 966-5933
Co-Authors:Anna Waller, J. Michael Bowling, and Deborah Flowers
Purpose: Research has shown poor reliability using conventional U.S. 3-level (3L) triage acuity scales (emergent, urgent, non-urgent), while studies in Australia and Canada report high reliability and validity of 5-level (5L) scales (I-resuscitation to 5-non-urgent). The goal of this study was to compare the reliability and validity of 3L and 5L triage scales.

Design: Setting and Sample: The time series study was conducted in a semi-urban academic ED with 60,000 annual visits. Stratified random samples of acuity ratings were selected for times 1 and 2. Excluded were patients not treated in ED, illegible triage nurse signature, and lack of triage nursing note.

Methodology: Reliability of 3L ratings was measured with kappa (time 1), then the 5L system was implemented kappa re-measured (time 2). Validity was assessed with case mix data for each time period, and by comparison to 5-level nursing resource intensity (NRI) scores and physician evaluation and management (EM) codes at time 2. Two expert ED nurses performed independent, retrospective acuity ratings using only the triage note, and then attempted to reach consensus as the gold standard. Other data included triage nurses' years of nursing experience.

Results: There were 305 triage ratings evaluated from time 1 and 244 from time 2. Weighted kappa for time 1 was 0.52 (CI 0.45-0.60), and for time 2 was 0.57 (CIO.50-0.64). At time 1, nurses with less than 6 years' experience were more likely to under-triage than those with more experience (p=O.003). At time 2, under-triage was 61 % for level 2; staff re-training is in progress to address this issue. Case mix at time 1 (15,324 patients) was: Level 1-6%, 2-36%, 3-59%, and at time 2 (16,024 patients) was: Level 1-1 %,2- 8%, 3- 38%, 4-41 %,513%. Spearman correlations were: 5L and NRI, 0.55 (p<O.OOO1), and 5L and EM, 0.57 (p<O.OOO1). Conclusions: The 5L provided greater discrimination than 3L, showed construct validity when compared to NRI and EM scores, and face validity with case mix data. There is a trend toward improved reliability with the 5L. Subsequent kappa measurements are planned after staff re-training. [Research Paper Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleComparison of 3-level and 5-level Triage Acuity Systemsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162766-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Comparison of 3-level and 5-level Triage Acuity Systems</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2000</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Travers, Debbie, MSN, RN, C, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Emergency Medicine, University of North Carolina</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">CB 7594, Chapel Hill, NC, 27599, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(919) 966-5933</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">dtravers@med.unc.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Anna Waller, J. Michael Bowling, and Deborah Flowers</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Research has shown poor reliability using conventional U.S. 3-level (3L) triage acuity scales (emergent, urgent, non-urgent), while studies in Australia and Canada report high reliability and validity of 5-level (5L) scales (I-resuscitation to 5-non-urgent). The goal of this study was to compare the reliability and validity of 3L and 5L triage scales.<br/><br/>Design: Setting and Sample: The time series study was conducted in a semi-urban academic ED with 60,000 annual visits. Stratified random samples of acuity ratings were selected for times 1 and 2. Excluded were patients not treated in ED, illegible triage nurse signature, and lack of triage nursing note.<br/><br/>Methodology: Reliability of 3L ratings was measured with kappa (time 1), then the 5L system was implemented kappa re-measured (time 2). Validity was assessed with case mix data for each time period, and by comparison to 5-level nursing resource intensity (NRI) scores and physician evaluation and management (EM) codes at time 2. Two expert ED nurses performed independent, retrospective acuity ratings using only the triage note, and then attempted to reach consensus as the gold standard. Other data included triage nurses' years of nursing experience.<br/><br/>Results: There were 305 triage ratings evaluated from time 1 and 244 from time 2. Weighted kappa for time 1 was 0.52 (CI 0.45-0.60), and for time 2 was 0.57 (CIO.50-0.64). At time 1, nurses with less than 6 years' experience were more likely to under-triage than those with more experience (p=O.003). At time 2, under-triage was 61 % for level 2; staff re-training is in progress to address this issue. Case mix at time 1 (15,324 patients) was: Level 1-6%, 2-36%, 3-59%, and at time 2 (16,024 patients) was: Level 1-1 %,2- 8%, 3- 38%, 4-41 %,513%. Spearman correlations were: 5L and NRI, 0.55 (p&lt;O.OOO1), and 5L and EM, 0.57 (p&lt;O.OOO1). Conclusions: The 5L provided greater discrimination than 3L, showed construct validity when compared to NRI and EM scores, and face validity with case mix data. There is a trend toward improved reliability with the 5L. Subsequent kappa measurements are planned after staff re-training. [Research Paper Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:46Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:46Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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