title: The effect of training on nurse agreement using an electronic triage system.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.
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: 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: 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