Emergency department patients’ self-perceived medical severity and urgency of care: The role of health literacy, stress and coping

Objectives

This study aimed to (1) compare the agreement between triage acuity and emergency department (ED) patients’ self-perceived medical severity and urgency, and (2) examine how health literacy, stress, and coping relate to patients’ perceptions of medical need and urgency.

Methods

In this cross-sectional, observational study, 171 patients from a large acute care teaching hospital in Southwestern Ontario were recruited in autumn 2020. English-speaking adults (18 + years) with Canadian Triage Acuity Scale (CTAS) scores from 2 (emergent) to 5 (non-urgent) were included. Patients completed surveys on stress (Perceived Stress Scale), coping (Brief Coping with Problems Experienced), and health literacy (Health Literacy Questionnaire). Electronic medical records linked ED utilization data with patient-reported data. Agreement between CTAS and patients’ self-assessed severity and urgency was analyzed using crosstabs and Cohen’s kappa.

Results

A total of 171 patients were recruited. There were no significant differences between ED patients with varying triage acuities and stress, coping, or health literacy levels. Cohen’s kappa statistics showed poor agreement between triage nurse-assigned scores and patients’ self-perceived medical severity and urgency of care. Those who overestimated were younger, single, had low medical acuity (CTAS 4/5), and lower understanding of how to navigate the health care system. Conversely, those who underestimated were older, married, and had high medical acuity (CTAS 2).

Conclusions

Future studies should focus on exploring the underlying factors (e.g., sociodemographic variables, clinical health information, and other personal attributes) contributing to discrepancies between patient-perceived severity and triage assessments in a larger, more representative sample.