Evaluation of triage nurse, doctor, nursing student inter-observer agreement on triage categorization in the emergency department at bach mai hospital

 Ngoc Ngo Duc, Hoa Can Thi

Hanoi Medical University, Hanoi, Vietnam

ABSTRACT

Triage is an important work in ED (emergency department), in situation of more patients waiting longer, the accuracy of the triage acuity level is more critical. Under-triage leaves the patient at risk for deterioration while waiting. Over-triage uses scarce resources, limiting availability of ED resources for another patient who may require immediate care.

Objectives

The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups: age, sex, diagnostic groups.

Methods

We conducted an observational study to compare agreement between the triage nurse, resident doctor and 4th year nursing student on categorization of 430 patients admitted to ED. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit.

Results

The overall nurse-doctor, doctor-student, nurse-studentagreement on categorization was fair (kappa = 0.26), moderate (kappa = 0.424), substantial (kappa = 0.685) respectively. The levels of agreement within all subgroups were variable and low. The highest agreement concerned two subgroups of complaints: cerebrovascular (kappa = 0.420), cardiovascular (kappa = 0.313).The lowest agreement concerned onsubgroup: GI disorder (kappa = -0.024). There was that the older patient, the higher agreement between triage nurse and resident doctor. There was a slight agreement (kappa: 0.182) between triage nurse and resident doctor with female patient, fair agreement (kappa: 0.290) with male patient.

Conclusions

The overall nurse-doctor agreement on triage categorization was fair. The lack of agreement on triage decision making has important implications for EDs in which the priority of care is based on nursing triage categorization. Detailed triage protocol and continued researches are necessary to improve the agreement between nurse-physician triage categorization.

Key words

Triage, nurse-physician inter-observer agreement, emergency department

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