Abstract
PurposeTo identify emergency department triage accuracy using the Korean Triage and Acuity Scale (KTAS) and evaluate the causes of mistriage.MethodsThis cross-sectional retrospective study was based on 1267 systematically selected records of adult patients admitted to two emergency departments between October 2016 and September 2017. Twenty-four variables were assessed, including chief complaints, vital signs according to the initial nursing records, and clinical outcomes. Three triage experts, a certified emergency nurse, a KTAS provider and instructor, and a nurse recommended based on excellent emergency department experience and competence determined the true KTAS. Triage accuracy was evaluated by inter-rater agreement between the expert and emergency nurse KTAS scores. The comments of the experts were analyzed to evaluate the cause of triage error. An independent sample t-test was conducted to compare the number of patient visits per hour in terms of the accuracy and inaccuracy of triage.ResultsInter-rater reliability between the emergency nurse and the true KTAS score was weighted kappa = .83 and Pearson’s r = .88 (p < .001). Of 1267 records, 186 (14.7%) showed some disagreement (under triage = 131, over triage = 55). Causes of mistriage included: error applying the numerical rating scale (n = 64) and misjudgment of the physical symptoms associated with the chief complaint (n = 47). There was no statistically significant difference in the number of patient visits per hour for accurate and inaccurate triage (t = -0.77, p = .442).ConclusionThere was highly agreement between the KTAS scores determined by emergency nurses and those determined by experts. The main cause of mistriage was misapplication of the pain scale to the KTAS algorithm.
Highlights
As the emergency department (ED) utilization rate increases worldwide, it is imperative to reduce patient overcrowding, to ensure patient safety and to improve the efficiency of emergency care [1]
There was highly agreement between the Korean Triage and Acuity Scales (KTAS) scores determined by emergency nurses and those determined by experts
As triage scales should be matched to the specific medical environment in which they are used, the application of a triage scale developed for one country should be approached with caution when applied to another country
Summary
Triage was introduced to enhance the quality of emergency care by reducing the length of stay of patients and is applied to EDs [1, 2]. As triage scales should be matched to the specific medical environment in which they are used, the application of a triage scale developed for one country should be approached with caution when applied to another country. In Korea, 97.1% of tertiary hospitals and regional emergency medical centers used triage in 2012, along with various tools such as CTAS, ESI, ATS, and a triage scale based on the Korean Emergency Medical Service Act [4]. The need for a standardized triage system has increased and the Korean Triage and Acuity Scales (KTAS) based on the CTAS was developed and has been used nationwide since 2016 [5]
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