The accuracy of triage classification using Emergency Severity Index

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2024-11-10 DOI:10.1016/j.ienj.2024.101537

Krisada Suamchaiyaphum , Allison R. Jones , Shea Polancich

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引用次数: 0

Abstract

Introduction

Accurate emergency triage is essential for timely and appropriate care based on patient acuity. We sought to evaluate triage accuracy among emergency department (ED) nurses and examine potential influencing factors.

Methods

We conducted an observational study using an electronic medical record chart review of 100 patients admitted at one of three EDs in a large academic medical system in the southern United States from December 1 to 7, 2021. Descriptive statistics were used to summarize the data. We compared the nurses’ initial assigned triage acuity level documented in the medical chart with triage acuity assigned using the Emergency Severity Index Version 4 handbook and assessed inter-rater agreement using Cohen’s kappa coefficient.

Results

Overall triage accuracy was 67%, with most patients (62%) triaged as ESI level 3; under- and over-triage occurred in 25% and 8% of cases, respectively. Cohen’s kappa coefficient was 0.437, indicating moderate interrater reliability between the triage nurses and the ESI handbook. Triage accuracy varied across ED locations and patient characteristics of sex (male: 55.6%, female: 72.3%), type of complaint (trauma: 57.1%, non-trauma: 69.4%), shift (day: 63.5%, night: 73.0%), and mode of arrival (ambulance: 80.8%, ambulatory: 65.2%, and private vehicle: 37.5%).

Conclusion

Triage inaccuracy may be attributed to a combination of nursing- and patient-specific factors. Further study of those factors associated with triage accuracy is warranted.

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使用紧急情况严重程度指数进行分流分类的准确性。

简介准确的急诊分诊对于根据患者的严重程度及时提供适当的护理至关重要。我们试图评估急诊科（ED）护士的分诊准确性，并研究潜在的影响因素：我们使用电子病历对美国南部一家大型学术医疗系统的三个急诊科之一在 2021 年 12 月 1 日至 7 日期间收治的 100 名患者进行了观察研究。我们使用描述性统计来总结数据。我们将病历中记录的护士最初指定的分诊严重程度与使用《急诊严重程度指数第4版手册》指定的分诊严重程度进行了比较，并使用科恩卡帕系数评估了评分者之间的一致性：总体分诊准确率为 67%，大多数患者（62%）被分诊为 ESI 3 级；分诊不足和分诊过度分别占 25% 和 8%。科恩卡帕系数（Cohen's kappa coefficient）为 0.437，表明分诊护士和 ESI 手册之间的互评可靠性处于中等水平。分诊准确率因急诊室地点和患者性别（男性：55.6%，女性：72.3%）、主诉类型（创伤：57.1%，非创伤：69.4%）、轮班（白班：63.5%，夜班：73.0%）和到达方式（救护车：80.8%，门诊：65.2%，私家车：37.5%）而异：结论：分诊不准确可能是由护理因素和患者特定因素共同造成的。结论：分诊不准确可能是由护理人员和患者的特定因素共同造成的，因此有必要对这些与分诊准确性相关的因素进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.