Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/162970
Type:
Presentation
Title:
Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study
Abstract:
Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Hinrichs, Jennifer, RN, MSN, CCRN
P.I. Institution Name:Clarian Health Partners
Title:Clinical Nurse Specialist
Contact Address:702 N. Barnhill Dr., Indianapolis, IN, 46202, USA
Contact Telephone:(317) 274-4099
Co-Authors:Emily Dever, RN, CEN; Stephanie Haler, RN
Purpose: Multiple factors delineate the severity of infant illness, which can make triage of this patient population challenging. Triage may become especially difficult when the infant's illness is chronic and characterized by subtle and/or rapid changes. When the Emergency Severity Index (ESI) was implemented at this hospital (2003), it was well established as being highly reliable in adult patients. The purpose of this research was to determine intra- and inter-rater reliability of the ESI in infants. Design: Retrospective chart review. Setting: An urban, tertiary care pediatric emergency department in the Midwest with an average of 15,000 patients per year. Sample: The medical records of infants ranging from 1 to 12 months old were randomly selected from a two-month period of past ED records. Methodology: After reviewing each chart, the investigator recorded the original triage acuity assigned and the name of the triage nurse. An ESI expert as determined by this person's experience as a triage nurse (12 years) and having been instrumental in the ESI education when the ESI was implemented was also used in this study. Two de-identified copies of each chart were made; one copy was given to an ESI expert and the second copy was given to the nurse who originally triaged the patient. Utilizing emergency department documentation, the ESI expert and the triage nurse assigned acuity to the patient using the ESI method. For each case, reassignment of ESI triage acuity scores was performed by the ESI expert and triage nurse within 30 and 60 days following the original date of triage. Kappa coefficient and percentage of agreement was calculated to assess intra-rater and inter-rater reliability. For intra-rater reliability of the triage nurse, the original score was compared to the 30- and 60-day ESI scores determined by chart review. To assess inter-rater reliability, the ESI experts' triage acuity scores were compared to the triage nurses' scores. Results: The patient sample (N=80) had a mean age of 5.5 months (SD ± 3.2). The triage nurse sample (N=11) had a mean of 11.7 years experience in emergency nursing. Intra-rater reliability, reflected a kappa coefficient of .313 (95% CI = .157 - .469, t = 4.5, p < 001) with 53.9% score agreement within each nurse. Inter-rater reliability reflected a kappa coefficient of .325 (95% CI = .169 - .481, t = 4.7, p < 001) with 53.9% score agreement between triage nurses and the ESI expert. Conclusions: This pilot study demonstrated low ESI intra- and inter-rater reliability. Low intra-rater agreement was not related to improved ESI skill among our triage nurses, as inter-rater reliability was also low. The ESI is still a very new tool; therefore further research is necessary to evaluate its effectiveness in pediatric, and more specifically, infant populations. One possibility is that the ESI needs some adjustments in order to accurately triage the infant patient population. Additional research is also warranted to determine the effectiveness of educational/training methods on infant ESI for ED staff. Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study
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.titleEmergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162970-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hinrichs, Jennifer, RN, MSN, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Clarian Health Partners</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">702 N. Barnhill Dr., Indianapolis, IN, 46202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(317) 274-4099</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jhinrichs@clarian.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Emily Dever, RN, CEN; Stephanie Haler, RN<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: Multiple factors delineate the severity of infant illness, which can make triage of this patient population challenging. Triage may become especially difficult when the infant's illness is chronic and characterized by subtle and/or rapid changes. When the Emergency Severity Index (ESI) was implemented at this hospital (2003), it was well established as being highly reliable in adult patients. The purpose of this research was to determine intra- and inter-rater reliability of the ESI in infants. Design: Retrospective chart review. Setting: An urban, tertiary care pediatric emergency department in the Midwest with an average of 15,000 patients per year. Sample: The medical records of infants ranging from 1 to 12 months old were randomly selected from a two-month period of past ED records. Methodology: After reviewing each chart, the investigator recorded the original triage acuity assigned and the name of the triage nurse. An ESI expert as determined by this person's experience as a triage nurse (12 years) and having been instrumental in the ESI education when the ESI was implemented was also used in this study. Two de-identified copies of each chart were made; one copy was given to an ESI expert and the second copy was given to the nurse who originally triaged the patient. Utilizing emergency department documentation, the ESI expert and the triage nurse assigned acuity to the patient using the ESI method. For each case, reassignment of ESI triage acuity scores was performed by the ESI expert and triage nurse within 30 and 60 days following the original date of triage. Kappa coefficient and percentage of agreement was calculated to assess intra-rater and inter-rater reliability. For intra-rater reliability of the triage nurse, the original score was compared to the 30- and 60-day ESI scores determined by chart review. To assess inter-rater reliability, the ESI experts' triage acuity scores were compared to the triage nurses' scores. Results: The patient sample (N=80) had a mean age of 5.5 months (SD &plusmn; 3.2). The triage nurse sample (N=11) had a mean of 11.7 years experience in emergency nursing. Intra-rater reliability, reflected a kappa coefficient of .313 (95% CI = .157 - .469, t = 4.5, p &lt; 001) with 53.9% score agreement within each nurse. Inter-rater reliability reflected a kappa coefficient of .325 (95% CI = .169 - .481, t = 4.7, p &lt; 001) with 53.9% score agreement between triage nurses and the ESI expert. Conclusions: This pilot study demonstrated low ESI intra- and inter-rater reliability. Low intra-rater agreement was not related to improved ESI skill among our triage nurses, as inter-rater reliability was also low. The ESI is still a very new tool; therefore further research is necessary to evaluate its effectiveness in pediatric, and more specifically, infant populations. One possibility is that the ESI needs some adjustments in order to accurately triage the infant patient population. Additional research is also warranted to determine the effectiveness of educational/training methods on infant ESI for ED staff. Emergency Severity Index Intra- and Inter-rater Reliability in an Infant Sample: A Pilot Quality Study</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:18Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:18Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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