The Inter-rater Reliability of Triage in an Acute Care Emergency Department Setting

2.50
Hdl Handle:
http://hdl.handle.net/10755/162895
Type:
Presentation
Title:
The Inter-rater Reliability of Triage in an Acute Care Emergency Department Setting
Abstract:
The Inter-rater Reliability of Triage in an Acute Care Emergency Department Setting
Conference Sponsor:Emergency Nurses Association
Conference Year:2003
Author:Westman, Julie, RN, BSN, MED, CEN
Contact Telephone:604/682-2344
Co-Authors:Eric Grafstein, MD, FRCP(c) Emergency
Purpose: The intent of this clinical project was to assess the inter-rater reliability of nurses using a presenting complaint list that is linked to the CTAS triage level. Setting: The prospective study was conducted at St. Paul's Hospital, a Canadian inner city academic center. The project was conducted in an actual time clinical setting, considering agreement on exact triage level and also the presenting complaint system that was involved. Sample: A total of 15 pairs of nurses triaged 265 patients between August and November 2002. Methodology: The nurse assigned to the triage desk assessed a convenience sample of emergency patients and entered the presenting chief complaint into the production system on the computer. An additional nurse assigned to the Triage desk observed the patient interview and independently entered the same information on a dummy terminal. The nurses did not discuss their decisions. Each nurse also selected a subjective triage level without a PC link. Results: The study patients matched the actual emergency department case mix closely. Kappa statistics were 0.74 (95% CI 0.68 - 0.80) for PC linked triage agreement and 0.80 (95% CI 0.69 - 0.91) for agreement on major system involved. The agreement between the subjectively assigned acuity levels and the PC linked triage levels was 0.55 (95% CI 0.51 - 0.59). The nurses assigned fewer patients to levels 1, 2, 5. Nurses triaging subjectively are most likely to cluster patients in the triage levels of 3 and 4. Conclusion: The kappa statistic for inter-rater reliability was 0.74, indicating that nurses can reliably triage patients. A limitation of the current system is the lack of flexibility to override the prescribed triage level. An additional field in the computer system could be added to permit this flexibility. The field would allow the nurse to override the triage level and provide a reason for the override. [Research 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.titleThe Inter-rater Reliability of Triage in an Acute Care Emergency Department Settingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162895-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Inter-rater Reliability of Triage in an Acute Care Emergency Department Setting</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">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Westman, Julie, RN, BSN, MED, CEN</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">604/682-2344</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jrmoose@telus.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Eric Grafstein, MD, FRCP(c) Emergency</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The intent of this clinical project was to assess the inter-rater reliability of nurses using a presenting complaint list that is linked to the CTAS triage level. Setting: The prospective study was conducted at St. Paul's Hospital, a Canadian inner city academic center. The project was conducted in an actual time clinical setting, considering agreement on exact triage level and also the presenting complaint system that was involved. Sample: A total of 15 pairs of nurses triaged 265 patients between August and November 2002. Methodology: The nurse assigned to the triage desk assessed a convenience sample of emergency patients and entered the presenting chief complaint into the production system on the computer. An additional nurse assigned to the Triage desk observed the patient interview and independently entered the same information on a dummy terminal. The nurses did not discuss their decisions. Each nurse also selected a subjective triage level without a PC link. Results: The study patients matched the actual emergency department case mix closely. Kappa statistics were 0.74 (95% CI 0.68 - 0.80) for PC linked triage agreement and 0.80 (95% CI 0.69 - 0.91) for agreement on major system involved. The agreement between the subjectively assigned acuity levels and the PC linked triage levels was 0.55 (95% CI 0.51 - 0.59). The nurses assigned fewer patients to levels 1, 2, 5. Nurses triaging subjectively are most likely to cluster patients in the triage levels of 3 and 4. Conclusion: The kappa statistic for inter-rater reliability was 0.74, indicating that nurses can reliably triage patients. A limitation of the current system is the lack of flexibility to override the prescribed triage level. An additional field in the computer system could be added to permit this flexibility. The field would allow the nurse to override the triage level and provide a reason for the override. [Research Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:35:59Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:35:59Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.