A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

Abstract

Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED) workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS) performance. Methods. A trained nurse reviewer (NR) retrospectively triaged two separate month's ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604). Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts.

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

“…[38,39] There are different studies about the accuracy, reliability and validity of 5-level triage systems for the acute patient triage. [21,[32][33][34][35][36][37] In an observational study including 486 patients by Worster et al, [36] there was no statistical difference between ESI and CTAS triage systems. In a study including 900 patients conducted by eight educated triage nurses, in which Storm-Versloot et al [33] used MTS and ESI without using a triage algorithm, it was reported that ESI had a lower triage score than MTS (11% to 20%).…”

“…[20] It was also shown that the triage level application has changed according to the number of incoming patients; while 5-level ESI triage system applied in 78.3% of crowded emergency departments having more than 100.000 or more annual urgent patients, 3-level triage system has been applied in 60.2% of the emergency departments having less than 1.000 annual urgent patients. [20,21] As suggested in the statement published in 2009 by the Ministry of Health of Turkish Government, the 3-level triage system has been commonly used in Turkey. In 3-level triage system, patients are categorized as emergent (red), urgent (yellow) and non-urgent (green).…”

“…[15,[29][30][31] There are various studies about accuracy, reliability and validity of acute patient triage in ATS-NTS, MTS, CTAS and ESI 5-level systems. [21,[32][33][34][35][36][37] ESI 5-level triage system which is widely used and has high value in US has been developed by emergency physicians, Richard Wuerz and David Eitel. In this system, patients are categorized from triage level 1-2 (life-threatening and critical conditions) to triage level 3-5 (diseases according to the necessities for expected sources usage).…”

Embracing the wild profusion: A Foucauldian analysis of the impact of healthcare standardization on nursing knowledge and practice

“…However, there are also notable limitations to the standardization of triage. Multiple studies demonstrate that the CTAS system has low inter‐rater agreement, with nurses inconsistently categorizing patients (Dallaire, Poitras, Aubin, Lavoie, & Moore, ; Howlett & Atkinson, ). Notably, in many of the research studies conducted on CTAS inter‐rater agreement and reliability, disagreement is inherently assumed to be undesirable (Dallaire et al., ; Fernandes et al., ); differing interpretations of acuity represents a breach of standardization in which a triage nurses’ personal subjectivities or inadequate education or experience result in inappropriate decision‐making (Dallaire et al., ).…”