STUDY OBJECTIVE
The purpose of this study is to examine emergency nurses' performance using triage scenarios characterized by type of patient population (adult versus pediatric) and mode of delivery (paper versus computer).
METHODS
A combination of paper-based (script alone) and computer-based (script plus still photographs) triage scenarios were used. Of the 28 scenarios used, half were written and half were computer based. Within each subgroup, there were 7 adult and 7 pediatric scenarios. Participants were asked to allocate an Australasian Triage Scale category for each triage scenario.
RESULTS
One hundred sixty-seven participants completed a total of 2,349 adult scenarios, and 161 participants completed 2,265 pediatric scenarios. Sixty-one percent of the triage decisions made by the nurses were "expected" triage decisions, 18% were "undertriage," decisions, and 21% were "overtriage" decisions. Nurse triage allocation decisions for the scenarios containing still photographs delivered by computer demonstrated a higher average agreement percentage of 66.2% (kappa=0.56; tau b =0.77; P <.0001) compared with the average agreement percentage of 55.4% (kappa=0.42; tau b =0.75; P <.0001) using paper-based (text-only) scenarios.
CONCLUSION
The mode of delivery appeared to have an effect on the nurses' triage performance. It is unclear whether the use of simple still photographs used in the computer mode of delivery resulted in a higher incidence of expected triage decisions and, thus, improved performance. The use of cues such as photographs and video footage to enhance the fidelity of triage scenarios may be useful not only for the education of triage nurses but also the conduct of research into triage decisionmaking. However, further exploration and research in this area are warranted.
[1]
S Thomas,et al.
Triage nurses' decisions using the National Triage Scale for Australian emergency departments.
,
2000,
Accident and emergency nursing.
[2]
G. Williams.
Sorting out triage.
,
1992,
Nursing times.
[3]
D Richardson,et al.
No relationship between emergency department activity and triage categorization.
,
1998,
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.
[4]
S Thomas,et al.
Clinical decisions using the National Triage Scale: how important is postgraduate education?
,
2001
.
[5]
Jane Marie Cioffi,et al.
Triage decision making: educational strategies.
,
1999,
Accident and emergency nursing.
[6]
J. R. Landis,et al.
The measurement of observer agreement for categorical data.
,
1977,
Biometrics.
[7]
Stephen Doherty.
Application of the national triage scale is not uniform
,
1996
.
[8]
T. Bucknall,et al.
Why we do the things we do: applying clinical decision-making frameworks to triage practice.
,
1999,
Accident and emergency nursing.
[9]
D. Schriger,et al.
Effect of visual cues, vital signs, and protocols on triage: a prospective randomized crossover trial.
,
1998,
Annals of emergency medicine.
[10]
Richard C. Wuerz,et al.
Inconsistency of Emergency Department Triage
,
1998
.