Abstract
Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
Highlights
In emergency rooms (ERs), seconds and minutes are important for the patient because this time may determine the distance between the time of death, serious disability or return to life [1]
Most patients (96.4%) were referred to the ER by their family. 37.1% and 74.8% of patients were admitted to the ER in the night shift and during the working days respectively. 67.6% of patients were discharged
Kappa coefficient agreement between the nurse’s triage and the final triage by the physician was 0.659, which showed an average level of agreement between the two groups
Summary
In emergency rooms (ERs), seconds and minutes are important for the patient because this time may determine the distance between the time of death, serious disability or return to life [1]. An incorrect triage leads to a waste of resources, delays in patients’ treatment, discontent and undesirable consequences [4] One of these triage systems is Emergency Severity Index (ESI) system, which in 1999, its first edition was developed by Wuerz and Eitel, and four editions have been conducted so far [1]. Undertriage refers to situations where the triage nurse estimates the patient acuity less than the actual level and causes delay in patient’s treatment. Undertriage in ED can lead to side effects for hospitalized patients during their stay in hospital, and on the other hand, overtriage mainly creates problems in the consumption of resources and diverting medical staff from other important activities in the hospital [3]. The aim of this study was to (a) evaluate the accuracy of emergency nurses in patients’ correct triage using ESI and (b) determine the number of undertriaged and overtriaged patients
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