title: The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region.
abstract: BACKGROUND
  The Australasian Triage Scale aims to ensure that the triage category allocated, reflects the urgency with which the patient needs medical assistance. This is dependent on triage nurse accuracy in decision making. The Australasian Triage Scale also aims to facilitate triage decision consistency between individuals and organisations. Various studies have explored the accuracy and consistency of triage decisions throughout Australia, yet no studies have specifically focussed on triage decision making in rural health services. Further, no standard has been identified by which accuracy or consistency should be measured. Australian emergency departments are measured against a set of standard performance indicators, including time from triage to patient review, and patient length of stay. There are currently no performance indicators for triage consistency.
  
  
  METHODS
  An online questionnaire was developed to collect demographic data and measure triage accuracy and consistency. The questionnaire utilised previously validated triage scenarios.(1) Triage decision accuracy was measured, and consistency was compared by health site type using Fleiss' kappa.
  
  
  RESULTS
  Forty-six triage nurses participated in this study. The accuracy of participants' triage decision-making decreased with each less urgent triage category. Post-graduate qualifications had no bearing on triage accuracy. There was no significant difference in the consistency of decision-making between paediatric and adult scenarios. Overall inter-rater agreement using Fleiss' kappa coefficient, was 0.4. This represents a fair-to-good level of inter-rater agreement.
  
  
  CONCLUSIONS
  A standard definition of accuracy and consistency in triage nurse decision making is required. Inaccurate triage decisions can result in increased morbidity and mortality. It is recommended that emergency department performance indicator thresholds be utilised as a benchmark for national triage consistency.
authors.affiliation: Emergency Department, Kalgoorlie Hospital, Western Australian Country Health Service, Australia; School of Nursing and Midwifery, Monash University, Australia. Electronic address: kylie.ekins@health.wa.gov.au.
authors.forename: Kylie
authors.initials: K
authors.lastname: Ekins
authors.affiliation: School of Nursing and Midwifery, Monash University, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Morphet
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D016529:Emergency Nursing / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012423:Rural Health / Q000592:standards*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014218:Triage / Q000592:standards*; D014904:Western Australia; D055815:Young Adult
keywords: Consistency; Decision Making; Emergency Nursing; Emergency Service, Hospital; Hospitals, Rural; Triage