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Accuracy and concordance of nurses in emergency department triage
Örebro University, Department of Health Sciences.
Örebro University, Department of Health Sciences.ORCID iD: 0000-0002-3964-196X
Örebro University, Department of Health Sciences.
2005 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 432-438Article in journal (Refereed) Published
Abstract [en]

In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7,550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

Place, publisher, year, edition, pages
2005. Vol. 19, no 4, p. 432-438
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-3166DOI: 10.1111/j.1471-6712.2005.00372.xOAI: oai:DiVA.org:oru-3166DiVA, id: diva2:137193
Available from: 2006-11-03 Created: 2006-11-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Registered nurse-led emergency department triage: organisation, allocation of acuity ratings and triage decision making
Open this publication in new window or tab >>Registered nurse-led emergency department triage: organisation, allocation of acuity ratings and triage decision making
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.

In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.

The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.

The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.

In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2006. p. 73
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 10
Keyword
Accuracy, Canadian Triage and Acuity Scale, concordance, decision making, emergency department, patient scenarios, registered nurses, survey, think aloud, triage
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-732 (URN)91-7668-504-7 (ISBN)
Public defence
2006-11-24, Aulan, Örebro universitet, Örebro, 13:00
Opponent
Supervisors
Available from: 2006-11-03 Created: 2006-11-03 Last updated: 2017-10-18Bibliographically approved

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Göransson, KatarinaEhrenberg, AnnaEhnfors, Margareta

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