title: Nurses' accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals.
abstract: BACKGROUND
  The Emergency Severity Index (ESI) is an English language emergency department patient triage tool. After translation, it has been adapted for use to triage patients in growing numbers of emergency departments in non-English-speaking countries. Few reports of the proficiency of triage nurses to score an ESI exist. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios.
  
  
  METHODS
  Triage nurses assigned an ESI score to each of 30 standard ESI (ESI Implementation Handbook Version 4) translated teaching case scenarios. Accuracy and Inter-rater reliability (Krippendorff's alpha) of the ESI scoring was measured. Nurses' subjective confidence applying the ESI algorithm was obtained by a Likert scale.
  
  
  RESULTS
  Sixty-nine nurses from four EDs participated in the study. They scored 59.6 % of the case scenarios correctly. Inter-rater reliability was 0.78 (Krippendorff's alpha). Most (54/69, 78 %) felt confident in their ability to apply the ESI.
  
  
  CONCLUSIONS
  Low accuracy of ESI score assignment was observed when nurses scored an ESI for 30 standard written case scenarios, translated into nurses' native language, despite a good inter-rater reliability and high nurse confidence in their ability to apply the ESI. Although feasible, using standard written case scenarios to determine ESI triage scoring effectiveness may not be the optimum means to rate nurses' triage skills.
authors: Institute of Nursing Science, University of Basel, Basel, Switzerland. Karin.Jordi@spital.so.ch.|Department of practice development, Hospitals of Canton Solothurn, Olten, Switzerland. Karin.Jordi@spital.so.ch.
authors: Karin
authors: K
authors: Jordi
authors: Emergency Department, University Hospital Basel, Basel, Switzerland. florian.grossmann@usb.ch.
authors: Florian
authors: F
authors: Grossmann
authors: St. Luke's Hospital of Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. ggaddis@saint-lukes.org.
authors: Gary M
authors: GM
authors: Gaddis
authors: Institute of Nursing Science, University of Basel, Basel, Switzerland. eva.cignacco@unibas.ch.
authors: Eva
authors: E
authors: Cignacco
authors: Institute of Nursing Science, University of Basel, Basel, Switzerland. kris.denhaerynck@usb.ch.
authors: Kris
authors: K
authors: Denhaerynck
authors: Institute of Nursing Science, University of Basel, Basel, Switzerland. rene.schwendimann@unibas.ch.
authors: René
authors: R
authors: Schwendimann
authors: Emergency Department, University Hospital Basel, Basel, Switzerland. christian.nickel@usb.ch.
authors: Christian H
authors: CH
authors: Nickel
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004509:Education, Nursing, Continuing; D016529:Emergency Nursing / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013557:Switzerland; D015599:Trauma Severity Indices; D014218:Triage