Inter-Rater Reliability of Triage Emergency Patients between Out Patient Department & Out Patient Department Accident Emergency Nurses and Emergency Physicians, Srinagarind Hospital

Abstract

Background and objective  : One of the common problems of out  patient department (OPD) triage is contradictory levels of patients between OPD nurses and OPD Accident Emergency (OPDAE) nurses, leading to over triage causing Emergency Department overcrowding or undertriage causing delayed management. So Emergency physicians have developed the five levels of  triage tool called “Srinagarind Emergency Severity Index” (SESI); 1. resuscitation 2. emergency 3. urgency 4. less urgency and 5. non-urgency and are used to train for triage personnels. The objective of this study was to evaluate the staffs agreement of   patient levels that was triaged among OPD nurses, OPD AE nurses and Emergency physicians.

Methods : The prospective study was designed. The study population were patients who come to OPD triage station of Srinagarind hospital and needed to be transfered to the OPD AE after being triaged by the OPD nursess. The OPD AE nurses assessed and determined triage levels. Recorded data were chief complaint, general appearance, vital signs, pain score, oxygen saturation were sent to the Emergency physicians to determine the triage levels. Data of 94 patients were recorded from October 10^th, 2013 until April 10^th 2014. Inter-rater reliability of triage among the OPD nurses, OPD AE nurses and Emergency physicians was tested by Kappa coefficient.

Results  : Inter-rater reliability of triage levels among OPD nurses, OPD AE nurses and Emergency physicians were fair ((kappa=0.2668, p=0.001). The resuscitation levels were the most agreement group. Triage levels between OPD nurses and OPD AE nurses were quite contradictory (Kappa=0.1708, p=0.006), also between OPD AE nurses and Emergency physicians (Kappa=0.1667, p=0.004), between 1^st and 2^nd Emergency physicians were substantial agreement (Kappa=0.6531, p=0.001)

Conclusions : Inter-rater reliability triage of patients among OPD nurses, OPD AE nurses and Emergency physicians was quite contradictory especially in urgency level but was related in resuscitation level.