Abstract
Introduction: Triage plays an essential role in the Emergency Department (ED), helping maintain a safe patient flow. Although assessing the quality of the triage process is crucial, to date, there has been no metrological testing of a tool measuring the quality of nursing triage. Objective: This study aimed to assess the interrater reliability of the Audit Triage Tool (ATT) in Quebec, Canada. Methods: This retrospective cohort study took place in a regional ED. Fifty triages were selected using a systematic random sampling technique with quotas of 10 triages grouped under 5 chief complaints: chest pain, abdominal pain, neurological problems, major blunt trauma and fever. A total of 4 auditors individually applied the 49 criteria of the ATT to 50 triages. The interrater reliability was measured with the intraclass correlation coefficient (ICC), percentage of unanimity (PU) and percentage of agreement (PA). Results: Based on the ICC, 33/49 criteria showed fair (ICC 0.60, comparatively to only 2/26 implicit criteria. Discussion and conclusion: Findings showed that a quarter of the ATT criteria had poor interrater reliability according to various statistical tests. Solutions to improve the reliability of the ATT, mostly regarding the implicit criteria, are needed. Finally, future methodological research on triage quality assessment should focus on a thorough validation of the ATT.
Highlights
Triage plays an essential role in the Emergency Department (ED), helping maintain a safe patient flow
The interrater reliability was measured with the intraclass correlation coefficient (ICC), percentage of unanimity (PU) and percentage of agreement (PA)
Solheim (2016) summarizes the triage process in seven steps: 1Perform a quick look; 2- Obtain the chief complaint from the patient; 3- Identify if the patient meets the immediate bedding criteria; 4- Document the complete triage; 5- Determine the priority level according to the triage scale used (P1Resuscitation: immediate care, P2-Emergent: 15 minutes, P3-Urgent: 30 minutes, P4-Less Urgent: 60 minutes and P5-Non Urgent: 120 minutes); 6Initiate appropriate treatment or diagnostic test (EKG, Xray and blood test protocols, etc.); 7- Re-evaluate the patient or re-evaluate
Summary
Results: Based on the ICC, 33/49 criteria showed fair (ICC < 0.60) or poor (ICC < 0.40) interrater reliability This number decreased to 18/49 when adding complementary statistical test: PU < 60 % or PA < 80 %. The adequacy of patient management for those requiring priority care, depends mainly on the quality of the triage performed by the nurse upon their arrival at the ED (Ordre des infirmiers et infirmières du Québec [OIIQ] & Collège des médecin du Québec [CMQ], 2019). This is a complex task that requires knowledge, clinical judgment and intuition from the nurse (Corbett & Quinn Griffin, 2016). For step 3, immediate bedding criteria, all three are required: 3.1- Obviously ill or injured, 3.2- Open bed (currently available or able to obtain rapidly) and 3.3- Available care providers (nursing or physician)
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