Inter-rater Reliability of Triage of Patients among Outpatient Department, Accident and Emergency Department Nurses and Emergency Physicians in Srinagarind Hospital

Abstract

Background and Objectives:Srinagarind Emergency Severity Index (SESI) was the triage assessment tool that used to solve contradictory triage between Outpatient Department (OPD) and Emergency Department (ED) nurses, but never evaluated reliability. The objective of this study was to evaluate the inter-rater reliability of the tool among OPD nurses and ED nurses as well as emergency physicians in Srinagarind Hospital.

Methods: A descriptive study was designed. Samples were 94 patients who were triaged by OPD nurses as emergency patient and needed transfer to ED. Patients’ data were collected from OPD and ED triage forms and sent them to two emergency physicians for triage level. Inter-rater reliability of triage of patients’ levels among OPD nurses, ED nurses and emergency physicians was tested by Kappa coefficient.

Results: Triage patients by OPD and ED nurses varied widely (K = 0.17, p = 0.006), as did triage by ED nurses and emergency physicians (K = 0.17, p = 0.004). Triage of patients by 1^st and 2^nd emergency physicians showed substantial agreement (K = 0.65, p = 0.001). Inter-rater reliability of triage level among OPD and ED nurses and emergency physicians was fair (K = 0.27, p = 0.001). The resuscitation level had the most agreement (K = 0.31, p = 0.001).

Conclusions:Inter-rater reliability of triage of patients among OPD nurses, ED nurses and emergency physicians were quite inconsistent especially at urgency level.