title: Do emergency nurses and doctors agree in their triage assessment of dyspneic patients?
abstract: OBJECTIVE
  This study investigated the inter-observer agreement (IOA) between doctors and nurses on triaging adult ED dyspneic patients.
  
  
  METHODS
  This was a prospective observational study comparing eight trained ED nurses with doctors. Each patient was assessed by a nurse and two doctors (1 and 2) who decided on four-point Patient Acuity Category (PAC) and triage management steps. The primary outcome was the proportion of resuscitation room escalations from consult. Secondary outcomes included proportions and IOA of assigned PAC and steps in triage management. The investigators reported IOA as the k statistic (95% CIs) and percent agreement.
  
  
  RESULTS
  There were 22/302 (7.3%) escalations; one from clinical deterioration. Proportions of assigned PAC status by nurses, Drs 1 and 2 were: PAC 1: 20.2-24.2%; PAC 2: 71.5-72.8%; PAC 3: 4.3-7.0%; PAC 4: 0.0-0.7%. The IOA was at least fair to moderate [k: 0.33 (0.22-0.43) to 1.00] in all steps of management except for electrocardiogram [k: 0.19 (0.10-0.27) to 0.45 (0.35-0.55)] ordering. The percent agreement ranged from 81 to 100% for all management steps except for chest Xray (66-73%) and electrocardiogram (61-71%) ordering.
  
  
  CONCLUSIONS
  Trained ED nurses were safe and managed adult dyspneic patients as well as doctors at triage.
authors.affiliation: Tan Tock Seng Hospital, Emergency Department, Singapore. Electronic address: Beng_Leong_Lim@ttsh.com.sg.
authors.forename: Beng Leong
authors.initials: BL
authors.lastname: Lim
authors.affiliation: Tan Tock Seng Hospital, Emergency Department, Singapore.
authors.forename: Xing Mei
authors.initials: XM
authors.lastname: Liew
authors.affiliation: Tan Tock Seng Hospital, Emergency Department, Singapore.
authors.forename: Alicia
authors.initials: A
authors.lastname: Vasu
authors.affiliation: Tan Tock Seng Hospital, Emergency Department, Singapore.
authors.forename: Kim Chai
authors.initials: KC
authors.lastname: Chan
mesh_terms: D000067289:Behavior Observation Techniques; D002983:Clinical Competence; D004417:Dyspnea / Q000175:diagnosis* / Q000451:nursing; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D009720:Nurse Clinicians / Q000592:standards*; D010820:Physicians / Q000592:standards*; D014218:Triage / Q000379:methods / Q000592:standards*
keywords: Doctors; Dyspneic; Emergency; Nurses; Triage