title: Interrater reliability of the Australasian Triage Scale for mental health patients.
abstract: OBJECTIVE
  To evaluate interrater reliability of the Australasian Triage Scale (ATS) for mental health patients in ED.
  
  
  METHODS
  In a prospective descriptive study, triage nurses were shown video vignettes of simulated scenarios of mental health presentations. Trieurs (raters) were asked to allocate an ATS category (rating) to each case. The primary outcome was the degree of interrater reliability for each simulated case. Also assessed were differences between raters or settings, grouped by level of ED activity, state of origin, hospital type and familiarity with appropriate guidelines. Chi-squared analysis was used for independent categorical variables; the Friedman test was used to compare the triage scores between busy and quiet ED scenarios. Ordinal data results were compared using opartchi.
  
  
  RESULTS
  All 90 eligible participants were enrolled. The highest interrater concordance was 65.6% whereas the lowest interrater concordance was 53.3%. Significant association occurred between the distribution of triage ratings, ED activity level and the state of origin. A busy ED resulted in the assignment of a more urgent ATS category and decrease in concordance.
  
  
  CONCLUSIONS
  There is a need to develop and implement a validated, standardized national triage tool for mental health patients. The ATS per se is insufficient to ensure acceptable interrater reliability, particularly during busy periods in the ED, and between states. Given the influence the ATS has on key outcomes, it is imperative for this tool to be robust.
authors.affiliation: The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Creaton
authors.forename: Don
authors.initials: D
authors.lastname: Liew
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knott
authors.forename: Melissa
authors.initials: M
authors.lastname: Wright
mesh_terms: D044362:Australasia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D014218:Triage / Q000458:organization & administration*