title: The effectiveness of nurse-led outpatient referral triage decision making in pediatric otolaryngology.
abstract: OBJECTIVE
  To assess the effectiveness of nurse-led triage of outpatient referrals in an academic pediatric otolaryngology practice.
  
  
  METHODS
  Three hundred consecutive outpatient referrals were reviewed and triaged by two otolaryngology registered nurses and two attending pediatric otolaryngologists. The nurses received triage training. The referrals were triaged as 'routine' (to be seen within 2-3 months), 'semi-urgent' (to be seen within 6 weeks), or 'urgent' (to be seen within 2 weeks). Weighted Kappa statistics (correcting for chance agreement) were performed to assess for the degree of agreement. After the consultation visits, patient records were reviewed to determine whether any referrals had been inappropriately triaged by the nurses.
  
  
  RESULTS
  Overall, there was substantial agreement between all raters. Specifically, weighted Kappa statistics were as follows: surgeon 1, nurse 1: 0.708; surgeon 1, nurse 2: 0.670; surgeon 2, nurse 1: 0.762; surgeon 2, nurse 2: 0.647; nurse 1, nurse 2: 0.756; and surgeon 1, surgeon 2: 0.784. Review of patient charts after consultation showed that no referrals were deemed to be inappropriately triaged and no urgent cases had been missed.
  
  
  CONCLUSIONS
  Our model of nurse-led triage of outpatient referrals was found to be effective and safe. Similar systems may be considered in other areas of medicine as a viable and acceptable alternative to the traditional physician-led triage practice.
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada; School of Human Communication Disorders, Dalhousie University, Halifax, NS, Canada. Electronic address: Paul.Hong@iwk.nshealth.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Hong
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Krista
authors.initials: K
authors.lastname: Ritchie
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Beaton-Campbell
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Cavanagh
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Belyea
authors.affiliation: IWK Health Centre, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Gerard
authors.initials: G
authors.lastname: Corsten
mesh_terms: D000553:Ambulatory Care; D002648:Child; D003657:Decision Making; D006801:Humans; D024802:Nurse's Role; D015588:Observer Variation; D010036:Otolaryngology; D010372:Pediatrics; D012017:Referral and Consultation; D013041:Specialties, Nursing; D014218:Triage
keywords: Nurse triage; Nurse-led triage; Outpatient referrals; Pediatric otolaryngology; Surgical referrals