Nurses' accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals.

Karin Jordi,René Schwendimann,Eva Cignacco,Kris Denhaerynck,Gary M Gaddis,Christian H Nickel,Florian Grossmann

doi:10.1186/s13049-015-0142-y

Abstract

BackgroundThe Emergency Severity Index (ESI) is an English language emergency department patient triage tool. After translation, it has been adapted for use to triage patients in growing numbers of emergency departments in non-English-speaking countries. Few reports of the proficiency of triage nurses to score an ESI exist. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios.MethodsTriage nurses assigned an ESI score to each of 30 standard ESI (ESI Implementation Handbook Version 4) translated teaching case scenarios. Accuracy and Inter-rater reliability (Krippendorff’s alpha) of the ESI scoring was measured. Nurses’ subjective confidence applying the ESI algorithm was obtained by a Likert scale.ResultsSixty-nine nurses from four EDs participated in the study. They scored 59.6 % of the case scenarios correctly. Inter-rater reliability was 0.78 (Krippendorff’s alpha). Most (54/69, 78 %) felt confident in their ability to apply the ESI.ConclusionsLow accuracy of ESI score assignment was observed when nurses scored an ESI for 30 standard written case scenarios, translated into nurses’ native language, despite a good inter-rater reliability and high nurse confidence in their ability to apply the ESI. Although feasible, using standard written case scenarios to determine ESI triage scoring effectiveness may not be the optimum means to rate nurses’ triage skills.

Highlights

IntroductionVarious standardized scoring rubrics exist to sort and rank patients
Triage is a sorting process by which Emergency Department (ED) clinicians prioritize patients for care at their time of arrival to an ED
Applying written patient case scenarios from the Emergency Severity Index (ESI) handbook for triage competency testing in four Swiss EDs resulted in low accuracy, despite good inter-rater reliability and high confidence of triage nurses that they could correctly use the ESI

Summary

Introduction

Various standardized scoring rubrics exist to sort and rank patients. The Emergency Severity Index (ESI) is one such rubric [1]. It is a reliable and valid [2,3,4] five-level instrument. Four times annually, refreshing nurse’s first day of implementation the knowledge in team meetings by of the ESI tool discussing cases. Four hours of training in ESI application, and, once a month, participation in a triage workshop. Three hours of training in ESI application, with supervision by an experienced ESI user, for each nurse’s first day of implementation of the ESI tool. The Emergency Severity Index (ESI) is an English language emergency department patient triage tool. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios

Methods

Results

Discussion

Conclusion