Pediatric Triage Variations Among Nurses, Pediatric and Emergency Residents Using the Canadian Triage and Acuity Scale

Abstract

Background Emergency care continues to be a challenge, since patients’ arrival is unscheduled and simultaneous which may fill the Emergency Department with non-urgent patients. Triaging is an integral part of every busy ED. The Canadian Triage and Acuity Scale (CTAS) is considered to be the most accurate and reliable tool for patient assessment worldwide. This study aims to identify the chosen triage level and compare the variation between registered nurses, pediatric and adult emergency residents by using CTAS cases. Methodology This study was conducted at King Abdulaziz Medical City, Saudi Arabia. A prospective self-administered questionnaire was used, and which contains 15 case scenarios with different triage levels. All cases were adopted from a Canadian triage course after receiving permission. Each case provides the patient’s symptoms, clinical signs and mode of arrival to the ED. The participants were instructed to assign a triage level using the following scale: 1=resuscitation, 2=emergent, 3=urgent, 4=less urgent, and 5=non-urgent. A non-random sampling technique was used for this study. Result A total of 151 participants completed the study questionnaire. 73 (48.34%) were nurses and 78 (51.66%) were residents (42 pediatric residents and 36 emergency residents). Each participant was given a score based on the correct answer for the case scenario. A mean score was compared among the nurses, pediatric residents and emergency residents. Since our data were not normally distributed, we used the Kruskal-Wallis test to observe statistical differences between the groups. The Kruskal Wallis Post-Hoc test was performed to see which groups were statistically significant, and it was found that there was a significant difference between nurses and pediatrics residents (P value < 0.001). Moreover, there were no significant differences found between nurses and ER residents (P value > 0.05). Conclusion The triaging system was found to be a very important tool to prioritize patients based on their complaints. The results showed that nurses had the greatest experience in implementing patients on the right triage level. On the other hand, ER and pediatric residents demonstrated a need to develop more knowledge about CTAS and become exposed more to the triaging system during their training.