Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI) Triage
Archives of Academic Emergency Medicine,
Vol. 2 No. 4 (2014),
1 November 2014
,
Page 158-161
https://doi.org/10.22037/aaem.v2i4.129
Abstract
Introduction: Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI) system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI. Methods: This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients’ triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. To specify the association between the time interval of initial triage and patient final status, Chi-Square test was applied using SPSS 18 statistical software. Results: There was no significant difference between results of nurses and physicians triage (P<0/0001). The agreement level (kappa index) between two groups was 94% (95% CI: 0.931-0.957). Of 601 patients, 44.1% ones were hospitalized at the emergency department, 52.6% discharged and 3.3% died. The average of time interval between nursing triage and physician visit was 9.55 minutes at the level one triage, 21.64 minutes at level two, 26.03 minutes at level three, 26.93 minutes at level four, and 11.70 minutes at level five. Conclusion: It seems that there is an acceptable inter-rater agreement between emergency nurses and physicians regarding patients’ triage in terms of ESI system.- Triage
- nurses
- physician-nurse relations
- emergency medicine
How to Cite
References
Fernandes CM, Tanabe P, Gilboy N, et al. Five-level triage: a report from the ACEP/ENA Five-level Triage Task Force. J Emerg Nurs. 2005;31(1):39-50.
Goransson K, Ehrenberg A, Marklund B, Ehnfors M. Accuracy and concordance of nurses in emergency department triage. Scand J Caring Sci. 2005;19(4):432-8.
Platts-Mills TF, Travers D, Biese K, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med. 2010;17(3):238-43.
Shojaee M, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chin J Traumatol. 2014;17(1):19-24.
Hashemi B, Baratloo A, Rahmati F, et al. Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine. Emergency. 2013;1(1):20-3.
Roukema J, Steyerberg EW, van Meurs A, Ruige M, van der Lei J, Moll HA. Validity of the Manchester Triage System in paediatric emergency care. Emerg Med J. 2006;23(12):906-10.
van Veen M, Steyerberg EW, Ruige M, et al. Manchester triage system in paediatric emergency care: prospective observational study. BMJ. 2008;337:a1501.
van Veen M, Steyerberg EW, Van't Klooster M, et al. The Manchester triage system: improvements for paediatric emergency care. Emerg Med J. 2012;29(8):654-9.
Dallaire C, Poitras J, Aubin K, Lavoie A, Moore L, Audet G. Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses. CJEM. 2010;12(1):45-9.
Fernandes CM, McLeod S, Krause J, et al. Reliability of the Canadian Triage and Acuity Scale: interrater and intrarater agreement from a community and an academic emergency department. CJEM. 2013;15(4):227-32.
Gravel J, Gouin S, Goldman RD, et al. The Canadian Triage and Acuity Scale for children: a prospective multicenter evaluation. Ann Emerg Med. 2012;60(1):71-7.e3.
Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. Dtsch Arztebl Int. 2010;107(50):892-8.
Manos D, Petrie DA, Beveridge RC, Walter S, Ducharme J. Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale. CJEM. 2002;4(1):16-22.
Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med. 2003;10(10):1070-80.
Lohr KN, Schroeder SA. A strategy for quality assurance in Medicare. N Engl J Med. 1990;322(10):707-12.
Shelton R. The Emergency Severity Index 5-level triage system. Dimens Crit Care Nurs. 2009;28(1):9-12.
Richardson JR, Braitberg G, Yeoh MJ. Multidisciplinary assessment at triage: a new way forward. Emerg Med Australas. 2004;16(1):41-6.
Storm-Versloot MN, Ubbink DT, Chin a Choi V, Luitse JS. Observer agreement of the Manchester Triage System and the Emergency Severity Index: a simulation study. Emerg Med J. 2009;26(8):556-60.
van der Wulp I, Schrijvers AJ, van Stel HF. Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study. Emerg Med J. 2009;26(7):506-9.
R SR. the witching hour: overcrowded emergency departments7. . Emerg Med news. 1992 (21):40-1.
Abbasi E NA, Nabipour I, Emami SR. Assessment of the level of knowledge of Physicians in Bushehr Province about preparedness and response for nuclear emergency. ISMJ. 2005;7:183–9. [Persion].
Esmailian M, Haj Zargarbashi E, Masoumi B, Karami M. Accuracy of Ultrasonography in Confirmation of Adequate Reduction of Distal Radius Fractures. Emergency. 2013;1(1): 7-10.
Heydari F, Esmailian M, Dehghanniri M. Diagnostic Accuracy of Ultrasonography in the Initial Evaluation of Patients with Penetrating Chest Trauma. Emergency. 2014;2(2):77-80.
Göransson KE, Ehrenberg A, Marklund B, Ehnfors M. Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs. 2006;14(2):83-8.
Goransson KE, von Rosen A. Interrater agreement: a comparison between two emergency department triage scales. Eur J Emerg Med. 2011;18(2):68-72.
Goransson KE, Ehrenberg A, Ehnfors M. Triage in emergency departments: national survey. J Clin Nurs. 2005;14(9):1067-74.
Worster A, Sardo A, Eva K, Fernandes CM, Upadhye S. Triage tool inter-rater reliability: a comparison of live versus paper case scenarios. J Emerg Nurs. 2007;33(4):319-23.
Martin A, Davidson CL, Panik A, Buckenmyer C, Delpais P, Ortiz M. An Examination of ESI Triage Scoring Accuracy in Relationship to ED Nursing Attitudes and Experience. J Emerg Nurs.[In Press].
Aloyce R, Leshabari S, Brysiewicz P. Assessment of knowledge and skills of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania. Afr J Emerg Med. 2014;4(1):14-8.
Vatnøy TK, Fossum M, Smith N, Slettebø Å. Triage assessment of registered nurses in the emergency department. Int Emerg Nurs. 2013;21(2):89-96.
Hosseini M, Bekry G, Mozaffari HR, et al. Effect of Educational Intervention on Oral Health Behaviour based on Health Belief Model in Female Secondary School Students of Paveh in 2011. Edu Res Med Sci J. 2014;2(3):2-9.
Göransson KE, Ehrenberg A, Ehnfors M. Triage in emergency departments: national survey. J Clin Nurs. 2005;14(9):1067-74.
Finamore SR, Turris SA. Shortening the wait: a strategy to reduce waiting times in the emergency department. J Emerg Nurs. 2009;35(6):509-14.
- Abstract Viewed: 331 times
- PDF Downloaded: 2721 times
