The effect of training on nurse agreement using an electronic triage system.
OBJECTIVE
Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training.


METHODS
This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted kappa) statistics.


RESULTS
In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted kappa = 0.55; 95% confidence interval [CI] 0.49-0.62); agreement improved in phase 2 (weighted kappa = 0.65; 95% CI 0.60-0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods.


CONCLUSIONS
Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.
Dong
Sandy L
SL
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.
Bullard
Michael J
MJ
Meurer
David P
DP
Blitz
Sandra
S
Holroyd
Brian R
BR
Rowe
Brian H
BH
D000328:Adult; D000416:Alberta; D016009:Chi-Square Distribution; D003658:Decision Making, Computer-Assisted; D016529:Emergency Nursing / Q000193:education* / Q000295:instrumentation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods* / Q000592:standards