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Inter-rater reliability of a computerized presenting-complaint–linked triage system in an urban emergency department

Published online by Cambridge University Press:  21 May 2015

Eric Grafstein ,
Grant Innes ,
Julie Westman ,
James Christenson  and
Anona Thorne
Eric Grafstein*
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC
Grant Innes
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC
Julie Westman
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC
James Christenson
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC
Anona Thorne
Affiliation:
Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC
*
Department of Emergency Medicine, St. Paul’s Hospital, 1085 Burrard St., Vancouver BC V6Z 1Y6; egrafstein@providencehealth.bc.ca

Abstract

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Background:

Triage reliability studies typically use hypothetical scenarios and weighted kappa scores where agreement within one level is considered satisfactory. But if triage category is used to help define ED case-mix groups for comparative or benchmarking processes, agreement on exact triage level and major system involved is important. Our hypothesis was that a computerized menu that links presenting complaints to preferred triage levels (PC-linked triage) would provide high triage reliability.

Objectives:

Our objective was to assess inter-rater reliability of PC-linked triage using the Canadian Emergency Department Triage and Acuity Scale (CTAS) in a real-time clinical setting, considering agreement on exact triage level and primary body system involved.

Methods:

On duty triage nurses entered patient presenting complaint and PC-linked triage level as per standard procedure. In a convenience sample of patients, a second nurse, blinded to triage assignment, observed the triage interaction and independently entered presenting complaint and triage level on a dummy terminal.

Results:

During the study, 15 nurse pairs triaged 266 patients. Study patients matched actual emergency department case mix closely. Triage nurses agreed exactly in 74% of cases and within one level in 94% of cases. The unweighted kappa value was 0.66 (95% confidence interval [CI], 0.60–0.73) and the quadratic weighted kappa value was 0.75 (95% CI, 0.68–0.81). Kappa for agreement on major system involved was 0.80 (95% CI, 0.69–0.91).

Conclusion:

PC-linked triage has high inter-rater reliability in a real-time clinical setting. PC-linked triage may be useful as one factor in defining case-mix groups for benchmarking and comparative purposes.

Keywords

Canadian Emergency Department Triage and Acuity ScaleCTASpresenting complaintsreliability
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 5 , September 2003 , pp. 323 - 329
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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