Rapid Emergency Triage Research Articles

Age is associated with increased mortality in the RETTS-A triage scale

BackgroundTriage is widely used in the emergency department (ED) in order to identify the patient’s level of urgency and often based on the patient’s chief complaint and vital signs. Age has been shown to be independently associated with short term mortality following an ED visit. However, the most commonly used ED triage tools do not include age as an independent core variable. The aim of this study was to investigate the relationship between age and 7- and 30-day mortality across the triage priority level groups according to Rapid Emergency Triage and Treatment System – Adult (RETTS-A), the most widely used triage tool in Sweden.MethodsIn this cohort, we included all adult patients visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015, n = 639,387. All patients were triaged according to the RETTS-A and subsequently separated into three age strata: 18–59, 60–79 and ≥ 80 years. Descriptive analyses and logistic regression was used. The primary outcome measures were 7- and 30-day mortality.ResultsWe observed that age was associated with both 7 and 30-day mortality in each triage priority level group. Mortality was higher in older patients across all triage priority levels but the association with age was stronger in the lowest triage group (p-value for interaction = < 0.001). Comparing patients ≥80 years with patients 18–59 years, older patients had a 16 and 7 fold higher risk for 7 day mortality in the lowest and highest triage priority groups, respectively. The corresponding numbers for 30-d mortality were a 21- and 8-foldincreased risk, respectively.ConclusionCompared to younger patients, patients above 60 years have an increased short term mortality across the RETTS-A triage priority level groups and this was most pronounced in the lowest triage level. The reason for our findings are unclear and data suggest a validation of RETTS-A in aged patients.

Lack of Prioritization Causes Extended Time to Assessment of Severely Injured Trauma Patients in a Resource-Scarce Emergency Department

Introduction:The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.Aim:To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.Methods:A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).Results:A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p &lt; 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).Discussion:The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.

Description of chest pain patients in a Norwegian emergency department

Objectives. Chest pain is one of the most frequent chief complaints in patients admitted to the emergency department (ED). No study has evaluated this patient population in Norway. The aim of the present study was to describe the diagnoses and logistics of chest pain patients admitted to the ED at a Norwegian university hospital. Design. Data were collected from all patients referred to the ED at St. Olav’s Hospital-Trondheim University Hospital in 2015. Patients presenting at the ED with a chief complaint of chest pain based on the Rapid Emergency Triage and Treatment System were included in this study. Results. In the study period, 22,403 patients were admitted to the ED. Chest pain was the second most common chief complaint (11%), only exceeded by acute abdominal pain (18%). Among the chest pain patients, 12% had acute coronary syndrome (ACS) and 37% were diagnosed with non-specific chest pain. Gastrointestinal, musculoskeletal, and pulmonary conditions were less common, affecting 6%, 4%, and 4% of the patients, respectively. In total, 90% of the ED chest pain patients were handled by the Clinic of Cardiology. Conclusions. Chest pain was the second most common chief complaint among patients admitted to the ED, and most patients were handled by the Clinic of Cardiology. More than one-third of the patients received a cardiac diagnosis, but the largest group of patients was discharged with a diagnosis of non-specific chest pain. Other conditions managed by non-cardiac medical specialties were less common.

Potential benefits of triage for the trauma patient in a Kenyan emergency department

BackgroundImproved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.MethodsA prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician’s assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.ResultsA total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.ConclusionThe results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

BackgroundThe assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.MethodsA prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics.ResultsThe dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years.ConclusionsDespite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

Capillary and venous lactate measurements with a handheld device compared to venous blood-gas analysis for emergency patients

Background/aimEarly identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method.MethodsPatients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study. Capillary (CAP) and venous (VEN) blood were analyzed with Accutrend Plus (AP). Venous blood samples were analyzed at the local hospital laboratory (GEM premier 4000) within 20 min from sampling. All sampling was conducted by two registered nurses specially trained in prehospital care.Results480 lactate measurements were performed in 160 patients. The mean difference between measurements in capillary blood compared with the reference method was 0.7 mmol/L and for venous blood 0.9 mmol/L. The limits of agreement from the Bland-Altman plot was − 0.9 to + 2.5 mmol/L and and − 0.1 to + 1.9 mmol/L, for CAP and VEN compared with GEM.ConclusionOur results shows low accuracy and low precision with VEN / CAP measurements of lactate compared to reference GEM.

A descriptive study of registered nurses’ application of the triage scale RETTS©; a Swedish reliability study

BackgroundFrom a patient safety perspective, it is of great importance that decision support systems such as triage scales are evidence based. In the most recent national survey, the majority of Swedish Emergency Departments (EDs) apply the Swedish triage scale known as the Medical Emergency Triage Treatment Scale (METTS), subsequently renamed the Rapid Emergency Triage Treatment Scale (RETTS©). Despite national widespread implementation, there has been limited research on METTS/RETTS©. AimTo determine the reliability of application by registered nurses of the RETTS© triage scale in two Swedish emergency departments. MethodsIn this prospective, cross-sectional study at two EDs, 46 written patient scenarios were triaged by 28 registered nurses (RNs). Data were analysed with descriptive statistics and Fleiss kappa (κ). ResultsThe RNs allocated 1281 final triage levels. There was concordance in seven (15%) of the scenarios, and dispersion over two or more triage levels in 39 (85%). Dispersion across the stable/unstable patient boundary was found in 21 (46%) scenarios. Fleiss κ was 0.562, i.e. moderate agreement. ConclusionThe inability of the triage scale to distinguish between stable/unstable patients can lead to serious consequences from a patient safety perspective. No general pattern regarding concordance or dispersion was found.

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality \u2013 a prospective study of patients admitted with infection to the emergency department

BackgroundWe aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS).MethodsThe study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients’ electronic records (EPR) and mortality data from the Norwegian population registry.ResultsOf the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert.DiscussionIn order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival.ConclusionIn this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria.

Early prehospital assessment of non-urgent patients and outcomes at the appropriate level of care: A prospective exploratory study

IntroductionThe Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. MethodsThe study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. Results394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. ConclusionThis prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.

A Decision support system (DSS) for municipal nurses encountering health deterioration among older people.

BackgroundThis study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver.MethodsThis study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system.ResultsUsing elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system.ConclusionsThe results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating to the vital parameters among older people and the use of the decision support system.

The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population.

BackgroundVital signs are widely used in emergency departments. Previous studies on the association between vital signs and mortality in emergency departments have been restricted to selected patient populations. We aimed to study the association of vital signs and age with 1-day mortality in patients visiting the emergency department.MethodsThis retrospective cohort included patients visiting the emergency department for adults at Södersjukhuset, Sweden from 4/1/2012 to 4/30/2013. Exclusion criteria were: age < 18 years, deceased upon arrival, chief complaint circulatory or respiratory arrest, key data missing and patients who were directed to a certain fast track for conditions demanding little resources. Vital sign data was collected through the Rapid Emergency Triage and Treatment System – Adult (RETTS-A). Descriptive analyses and logistic regression models were used. The main outcome measure was 1-day mortality.ResultsThe 1-day mortality rate was 0.3 %. 96,512 patients met the study criteria. After adjustments of differences in the other vital signs, comorbidities, gender and age the following vital signs were independently associated with 1-day mortality: oxygen saturation, systolic blood pressure, temperature, level of consciousness, respiratory rate, pulse rate and age. The highest odds ratios was observed when comparing unresponsive to alert patients (OR 31.0, CI 16.9 to 56.8), patients ≥ 80 years to <50 years (OR 35.9, CI 10.7 to 120.2) and patients with respiratory rates <8/min to 8–25/min (OR 18.1, CI 2.1 to 155.5).DiscussionMost of the vital signs used in the ED are significantly associated with one-day mortality. The more the vital signs deviate from the normal range, the larger are the odds of mortality. We did not find a suitable way to adjust for the inherent influence the triage system and medical treatment has had on mortality.ConclusionsMost deviations of vital signs are associated with 1-day mortality. The same triage level is not associated with the same odds for death with respect to the individual vital sign. Patients that were unresponsive or had low respiratory rates or old age had the highest odds of 1-day mortality.

A reliability study of the rapid emergency triage and treatment system for children.

BackgroundTo evaluate inter- and intrarater reliability of a new Scandinavian triage system for children, the Rapid Emergency Triage and Treatment System-pediatric (RETTS-p).MethodsTwo observational studies were conducted at the Pediatric Emergency Department (PED), St. Olav’s University Hospital, Trondheim, Norway. Using RETTS-p, nurses assign one of five triage priority levels to each patient on the basis of clinical signs and symptoms evaluations and vital parameter measurements.Study 1: Prior to the introduction of RETTS-p in 2012, all nurses in the PED completed a theoretical and practical training. Four months later, 19 nurses triaged 20 fictive but realistic pediatric cases two times 9 months apart (Waves A and B). Study 2: Nurse pairs consisting of a regular nurse and a research nurse simultaneously and independently triaged 200 pediatric patients who were referred with various common medical and surgical complaints.ResultsStudy 1: Kendall’s W for Waves A and B were 0.822 and 0.844, respectively. Using a mixed linear model, we found no difference in triage priority levels between Waves A and B. Compared to a consensus level made by the research group, the nurses rated 85.1 % fictive cases correctly, and 99 % were rated correctly or within one adjacent priority score. Study 2: The interrater correlation coefficient in a linear mixed model was 0.762, confirming a high interrater reliability in real-life triaging.DiscussionWe found a very high degree of agreement between nurses who used RETTS-p to prioritize children, both in a theoretical case scenarios study, but also in real-life triaging.ConclusionsRETTS-p may be a credible and robust triage system, but it has not been validated yet.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0207-6) contains supplementary material, which is available to authorized users.

The predictive validity of RETTS-HEV as an acuity triage tool in the emergency department of a Danish Regional Hospital.

The Rapid Emergency Triage and Treatment System - Hospital Unit West (RETTS-HEV) is a triage system used in the emergency department (ED) in Herning, Denmark, since 2010. It categorizes patients according to priority and defines a time limit on how long patients can wait before being seen by a doctor depending on the severity of their condition. The purpose of this study was to determine the predictive validity of RETTS-HEV by measuring the association between triage scores and outcomes such as the admission rate, the length of stay (LOS), and mortality. We performed an observational cohort study by examining the medical records of all patients who attended the ED from 1 September 2012 to 30 November 2012, at the Regional Hospital West Jutland in Herning, Denmark (N=4680). We defined the following outcomes to make associations with the patients' triage category: in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS and the admission rate, on the basis of complete information from the Danish National Patient Registry. The distribution of age, comorbidity, admission, LOS, and mortality over triage categories differed as expected. After making adjustments for these differences, we found a consistent association between triage categories and in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS, and the admission rate. RETTS-HEV was found to be closely related to all examined outcomes, and therefore useful in the risk stratification of ED patients.

Early Assessment of Patient's Medical Condition in Ambulance Care Affects the Level of Care of Non Urgent Patients.

The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medical condition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition.

422 A Multicenter Study on the Comparison of Inter-Rater Reliability Between a Four- and a Five-Level In-Hospital Triage Scales

To compare the inter-rater reliability of an Italian four-level triage scale, the triage emergency methods (TEM v2), and a Swedish five-level triage scale, the Rapid Emergency Triage and Treatment System (RETTS). This is a validation multicenter study conducted in two Italian and two Swedish emergency departments (ED) from March 2014 to December 2014 . Inclusion criteria for center were: to perform triage using the TEM v2 (Italian centers) or RETTS (Swedish centers) scale. Ten nurses from Italian centers and ten nurses from Swedish centers were included if they had undergone a course in the triage scales during the last three years. We used 46 triage scenarios from a medical database. Each scenario included demographic and clinical characteristics: sex, age, main chief complaint at triage, past diseases, vital signs and pain score. Each participant independently assigned triage scores to the 46 scenarios using the TEM v2 or RETTS scale. We tested the inter-rater reliability using a kappa statistic and the Intraclass Correlation Coefficient (ICC) using STATA 13 software. A P < .05 was used to define statistical significance. The mean age of patients included in 46 scenarios was 43 years, 60% male; trauma was the main complaint. The nurses' triage experience from Italian and Swedish group was similar: mean 8.9 years (DS 5.7) vs 5.1 years (DS 2.1) years; median 8 years (range 1-20) vs 5.5 years (range 2.5-7.5); p =0.072. The rate distribution of high (level 1 and 2) and low triage levels was similar among Italian nurses (4-level TEM v2) and the Swedish nurses (5-level RETTS): high codes 28.3% (TEM) vs 43.5% (RETTS); 71.7% (TEM) vs 56.5% (RETTS). The overall inter-rater reliability was moderate-strong for RETTS: K = 0,42 (CI 95; 0.37-0.47), ICC = 0.96 (CI 95%; 0.65-0.98); good-almost perfect for TEM: k=0.66 (CI 95%; 0.61-0.71), ICC = 0.98(CI 95%; 0.97-0.99). The 4-level TEM showed a similar good inter-rater reliability among all triage acuity levels: K inter range from 0.60 (code 2) to 0.74 (code 4). The 5-level RETTS had the lowest reliability for code 4 (K inter =0.25), the best for code 1 (K inter= 0.6). The four- and five-level triage scales tested in this study showed a similar good inter-rater reliability. Our results are in contrast with previous studies which showed better performance of 5-level scales. Limitation is that there are triage scenarios and not real patients.

First evaluation of the paediatric version of the Swedish rapid emergency triage and treatment system shows good reliability

To investigate the reliability of Retts-p, Rapid emergency triage and treatment system-paediatric, with regard to inter-rater and intra-rater agreement. Twenty nurses responsible for triaging both children and adults at the Emergency Department, Östersund County Hospital, Sweden, were randomly selected to take part in the study. The nurses were asked to use the Retts-p triage system to retrospectively assess the written case reports on 40 paediatric cases, aged from 6 month to 17.5 years, who attended the Emergency Department in 2010 with surgical, orthopaedic and medical symptoms. Using the information provided regarding appearance, symptoms, previous medical history and vital signs, the nurses selected the most appropriate Emergency Symptoms and Signs algorithm and placed the child in one of the five triage categories. Two test rounds were performed, 3 months apart, using the same cases, to study both the inter-rater and intra-rater agreement for the priority level and the triage algorithm chosen by the triage nurses. Good to very good agreement were shown for both inter-rater (quadratic κw 0.86, 95% CI 0.85-0.87) and intra-rater testing (quadratic κw 0.92, 95% CI 0.88-0.96). Retts-p provided good to very good reliability in this first evaluation study of the triage system.

Inter-rater agreement of the triage system RETTS-HEV

The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system - hospital unit west) in a Danish emergency department (ED). The use of triage systems in Denmark has been implemented recently together with structural changes in hospital organization. Testing and evaluation is therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semilarge, with 29 000 annual visits. Consecutive patients presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss κ. A total of 155 patients were triaged over a 10-day period and complete data were available for 146 patients. We found the overall agreement to be good [Fleiss κ 0.60 (95% confidence interval 0.48; 0.72)]. The κ estimate was higher for the group of patients who required immediate attention [0.83 (95% confidence interval 0.18; 1.47)]. The study found good inter-rater agreement between two independent observers not receiving any new triage training before the study.