title: Optimizing triage consistency in Australian emergency departments: the Emergency Triage Education Kit.
abstract: OBJECTIVE
  The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme.
  
  
  METHODS
  A postal survey of 237 paper-based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was kappa >or= 0.6.
  
  
  RESULTS
  Data were collected during 2 April to 14 May 2007. Agreement for the set was kappa = 0.412 (95% CI 0.410-0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6-45.3) showed concordance >or=70% to the modal triage category (kappa = 0.632, 95% CI 0.629-0.636) and 155/237 (65.4%, 95% CI 59.3-71.5) showed concordance >or=60% to the modal triage category (kappa = 0.507, 95% CI 0.504-0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (kappa = 0.243, 95% CI 0.237-0.249; kappa = 0.319, 95% CI 0.310-0.328).
  
  
  CONCLUSIONS
  All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task-related factors influence consistency of triage.
authors.affiliation: The School of Nursing, The University of Melbourne, Melbourne, Australia. gerdtzmf@unimelb.edu.au
authors.forename: Marie Frances
authors.initials: MF
authors.lastname: Gerdtz
authors.forename: Marnie
authors.initials: M
authors.lastname: Collins
authors.forename: Matthew
authors.initials: M
authors.lastname: Chu
authors.forename: Audas
authors.initials: A
authors.lastname: Grant
authors.forename: Robin
authors.initials: R
authors.lastname: Tchernomoroff
authors.forename: Cecily
authors.initials: C
authors.lastname: Pollard
authors.forename: Judy
authors.initials: J
authors.lastname: Harris
authors.forename: Jeff
authors.initials: J
authors.lastname: Wassertheil
mesh_terms: D000328:Adult; D044362:Australasia; D004509:Education, Nursing, Continuing; D004635:Emergency Medicine / Q000193:education*; D016529:Emergency Nursing / Q000193:education*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D017146:Models, Organizational; D015403:Nursing Evaluation Research; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data