title: Interactive triage simulator revealed important variability in both process and outcome of emergency triage.
abstract: OBJECTIVE
  (1) to evaluate the performance of emergency department triage; (2) to explore the variability of the triage process; and (3) to examine the reliability of a four-level triage scale, using an interactive triage simulator.
  
  
  METHODS
  We developed 22 interactive computerized vignettes describing patients presenting at the Emergency Department. Each vignette displayed the presenting complaint and offered the possibility to ask questions and obtain vital signs before deciding on the triage severity rating. The vignettes were rated twice by 45 nurses and 8 physicians.
  
  
  RESULTS
  (1) The concordance between the observed triage decision and an expert-attributed emergency level was perfect in 58% of the situations. Triage acuity was overestimated in 11%, and underestimated in 31%. (2) There was a wide variability in the triage process across observers and vignettes. The mean number of questions varied from 1.77 to 18.95 across individuals, and from 3.96 to 11.60 across vignettes. (3) Finally, the test-retest reliability of our instrument was good (weighted kappa = 0.82) but the interrater reliability was moderate (weighted kappa = 0.41).
  
  
  CONCLUSIONS
  The computerized triage simulator is an innovative tool to evaluate the process and the performance of triage and to evaluate the reliability of a triage instrument.
authors.affiliation: Geneva University Hospital, Department of Medicine, Emergency Medicine Unit, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. olivier.rutschmann@hcuge.ch
authors.forename: Olivier T
authors.initials: OT
authors.lastname: Rutschmann
authors.forename: Michel
authors.initials: M
authors.lastname: Kossovsky
authors.forename: Antoine
authors.initials: A
authors.lastname: Geissbühler
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Bernard
authors.initials: B
authors.lastname: Vermeulen
authors.forename: Josette
authors.initials: J
authors.lastname: Simon
authors.forename: François P
authors.initials: FP
authors.lastname: Sarasin
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014218:Triage