title: Emergency triage: comparing a novel computer triage program with standard triage.
abstract: BACKGROUND
  Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed.
  
  
  OBJECTIVE
  To determine the agreement between a computer decision tool and memory-based triage.
  
  
  METHODS
  Consecutive patients presenting to a large, urban, tertiary care ED were assessed in the usual fashion and by a blinded study nurse using a computerized decision support tool. Triage score distribution and agreement between the two triage methods were reported. A random subset of patients was selected and reviewed by a blinded expert panel as a consensus standard.
  
  
  RESULTS
  Over five weeks, 722 ED patients were assessed; complete data were available from 693 (96%) score pairs. Agreement between the two methods was poor (kappa = 0.202; 95% confidence interval [95% CI] = 0.150 to 0.254); however, agreement improved when using weighted kappa (0.360; 95% CI = 0.305 to 0.415) or "within one" level kappa (0.732; 95% CI = 0.644 to 0.821). When compared with the expert panel, the nurse triage scores showed lower agreement (0.263; 95% CI = 0.133 to 0.394) than the tool (kappa = 0.426; 95% CI = 0.289 to 0.564). There was a significant down-triaging of patients when patients were triaged without the computerized tool. Admission rates also differed between the triage systems.
  
  
  CONCLUSIONS
  There was significant discrepancy by nurses using memory-based triage when compared with a computer tool. Triage decision support tools can mitigate this drift, which has administrative implications for EDs.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sandy L
authors.initials: SL
authors.lastname: Dong
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bullard
authors.forename: David P
authors.initials: DP
authors.lastname: Meurer
authors.forename: Ian
authors.initials: I
authors.lastname: Colman
authors.forename: Sandra
authors.initials: S
authors.lastname: Blitz
authors.forename: Brian R
authors.initials: BR
authors.lastname: Holroyd
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D002170:Canada; D003658:Decision Making, Computer-Assisted; D016529:Emergency Nursing / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014218:Triage / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data