title: Outcomes for emergency severity index triage implementation in the emergency department.
abstract: BACKGROUND
  Hospital triage scale in emergency departments needs to be valid and reliable. Lack of sufficient data exists on triage scale rigor in emergency departments of Iran. This study aimed to determine the impact of the emergency severity index (ESI) triage scale in the emergency department.
  
  
  METHODS
  A single-center study was conducted. Proportion of triage categories allocated to high-risk patients admitted to high-acuity departments was examined in observational period in June 2012 and May 2013. True triage score was reported based on patients` paper- based scenario questionnaire. Interrater reliability was assessed using unweighted kappa. Concordance among experts, nurses and physicians was examined. The Chi-square test and Kappa statistics was used for statistical analysis.
  
  
  RESULTS
  Triage decisions regarding high-risk patients before and after implementation period are independent from each other (χ2= 22.254; df=1; p<0.05) and more high-risk patients were recognized after implementation of the ESI. Overall agreement and concordance were (79%) and (κ=0.54) among nurses; (71%) and (κ=0.45) among physicians, (85%) and (κ=0.81) among experts, respectively. Correct triage decisions among clinicians were increased after implementation of the ESI.
  
  
  CONCLUSIONS
  The ESI as valid and reliable tool improving desirable outcomes` in the emergency department has been recommended but it may not reveal optimal outcomes in developing countries comparing to what have been achieved in the developed countries. In addition, patient influx in ESI level II could create considerable controversy with clinicians.
authors.affiliation: PhD Candidate, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad, Iran .
authors.forename: Amir
authors.initials: A
authors.lastname: Mirhaghi
authors.affiliation: Assistant Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad, Iran .
authors.forename: Hadi
authors.initials: H
authors.lastname: Kooshiar
authors.affiliation: Associate Professor, Department of Biostatistics, Mashhad University of Medical Sciences , Mashhad, Iran .
authors.forename: Habibollah
authors.initials: H
authors.lastname: Esmaeili
authors.affiliation: Assistant Professor, Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences , Mashhad, Iran .
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ebrahimi
keywords: Algorithm; ESI; Reliability