Interrater agreement: a comparison between two emergency department triage scales.
Summary of "Interrater agreement: a comparison between two emergency department triage scales."
OBJECTIVE:
The aim was to elucidate if, by strictly applying the Adaptive Process Triage (ADAPT) scale, the interrater agreement increased among the participating registered nurses (RNs) than when triaging according to the older scale, which allowed subjective interpretations of signs and symptoms.
METHODS:
Nineteen patient scenarios were triaged in 2006 by 45 RNs using the previous triage scale, and in 2008 by 30 RNs using ADAPT.
RESULTS:
There was no significant difference (P=0.65) between the two triage scales with regard to level of overall exact agreement (kappa value 0.529 vs. 0.472). The same triage level was more often chosen when using the ADAPT system as compared to the earlier triage scale and dispersion across the triage levels was also reduced when using ADAPT. Eight (42%) of the patient scenarios were triaged as both unstable and stable by ADAPT, and 11 (58%) when the older scale was applied. Fourteen (74%) of the scenarios could not be allocated to a defined triage level by ADAPT. Five main reasons for such triage decisions were identified.
CONCLUSION:
Both the triage scales showed moderate overall agreements, while dispersion of triage decisions across several triage levels declined when ADAPT was used. Although the algorithm for acuity allocation by ADAPT seemed well defined, many patient scenarios were triaged as both unstable and stable and thus allocated to various triage levels. If ADAPT is to function as a safe triage tool with low interrater variability, further revision of the triage algorithms is needed.
Affiliation
aDepartment of Emergency Medicine, Karolinska University Hospital Solna bDepartment of Neurobiology, Care Sciences and Society cDepartment of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
Journal Details
This article was published in the following journal.
Name: European journal of emergency medicine : official journal of the European Society for Emergency Medicine
ISSN: 1473-5695
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20679900
- DOI: http://dx.doi.org/10.1097/MEJ.0b013e32833ce4eb
Medical and Biotech [MESH] Definitions
Emergency Nursing
The specialty or practice of nursing in the care of patients admitted to the emergency department.
Emergency Service, Hospital
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
Cross-cultural Comparison
Comparison of various psychological, sociological, or cultural factors in order to assess the similarities or diversities occurring in two or more different cultures or societies.
Emergency Medical Technicians
Paramedical personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.
Transfer Agreement
A written agreement for the transfer of patients and their medical records from one health care institution to another.
PubMed Articles
Assessing psychotic-like symptoms using the BASC-2: adolescent, parent and teacher agreement.
AIM: The aim of the current study was to investigate the psychometric properties of the BASC-2 (Behavior Assessment System for Children, Second Edition) Atypicality subscale in a sample of adolescents...
A concept for major incident triage: full-scaled simulation feasibility study.
ABSTRACT: BACKGROUND: Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwe...
Pain assessments at triage with the Manchester triage system: a prospective observational study.
Objective Pain is one of the six general discriminators of the Manchester triage system (MTS). The frequency of pain assessments conducted at triage with the MTS, and patient, nurse and triage charact...
How serious are the symptoms of callers to a telephone triage call centre?
Adverse events such as deaths following telephone triage calls are rare, suggesting that the process is basically safe. However, if calls tend to concern mostly minor illnesses, then adverse events fo...
Improving quality through clinical risk management: a triage sentinel event analysis.
"Triage" is a useful tool used in emergency departments (EDs) to prioritize the care of patients. Through a methodical process of different sequential steps, the triage nurse assigns a color code whic...
Clinical Trials
The Canadian Triage and Acuity Scale for Children; A Prospective Multi-Center Evaluation.
The aim of this study is to evaluate the validity and the reproducibility of the canadian triage and acuity scale when applied by regular nurses for the triage of children in the Emergency...
Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT II)
The purpose of this study is to test whether physicians can make more informed treatment, admission, and discharge decisions related to patient care by having serial Triage® BNP test resu...
Evaluation of Emergency Triage Using a Computerized Simulator
A four-level triage scale (the Geneva Emergency Triage Scale, GETS) has been used since 1997 in our emergency department (ED). A recent evaluation of this scale showed that our instrument...
Rapid Assessment of Cardiac Markers for the Evaluation of Acute Coronary Syndrome (RACE-ACS)
This clinical trial is being conducted to 1) evaluate the possible usefulness of a panel of cardiac markers in assessing emergency department patients with possible acute coronary syndrome...
Multi-Marker INDex for the Risk Assessment of Sepsis in the Emergency departmenT (MINDSET)
The purpose of the study is to procure blood samples from patients ≥18 years of age who present to the Emergency Department (ED) with at least two of the diagnostic criteria for sepsis....
