The effect of centrality bias on triage nurses in the emergency department.

Abstract

Objective: To investigate whether centrality bias is one of the contributing factors for patient mistriage in the emergency department.

Methods: A randomized, controlled, single-blinded trial was conducted in an emergency department triage station between April 1 and November 3, 2021. Experienced triage nurses were divided into control and treatment groups. The control group triaged patients using the Canadian Triage and Acuity Scale 1-5 triage scale, and the treatment group used a four-level triage scale (created by removing level 3 from the original Canadian Triage and Acuity Scale). Neither group was exposed to the other's ranking and the control group determined the patient's actual triage ranking. The accuracy of each group's ranking was determined by triage experts. Triage nurses' levels of confidence was investigated, as was the correlation between triage ranking accuracy and confidence level.

Results: After excluding 58 patients with missing data, 146 assessments were analyzed. Statistical analysis was performed to compare three different aspects of triage rankings between the nurses' groups and the control group. In the first and second analyses, accuracy levels of 49% and 68% (p = 0.003), 43% and 68% (p < 0.0001) were found for the control and experimental groups, respectively. The third aspect showed no significant differences. Within the control and experimental groups, the difference in accuracy rate at levels 2 and 5 was the most significant, with 13% and 75% (p = 0.40), 29% and 67% (p = 0.009), respectively.

Conclusions: Central tendency has the potential to affect the accuracy of ranking among triage nurses in the emergency department. Further research is needed.