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The effect of training on nurse agreement using an electronic triage system

Published online by Cambridge University Press:  21 May 2015

Sandy L. Dong ,
Michael J. Bullard ,
David P. Meurer ,
Sandra Blitz ,
Brian R. Holroyd  and
Brian H. Rowe
Sandy L. Dong
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Alta.
Michael J. Bullard*
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Alta.
David P. Meurer
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Brian R. Holroyd
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Alta.
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Alta.
*
1G1.50 Walter C. Mackenzie Centre, University of Alberta Hospital, 8440 – 112 St., Edmonton AB T6G 2B7; michael.bullard@ualberta.ca.

Abstract

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Objectives:

Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training.

Methods:

This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted κ) statistics.

Results:

In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted κ = 0.55; 95% confidence interval [CI] 0.49–0.62); agreement improved in phase 2 (weighted κ = 0.65; 95% CI 0.60–0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods.

Conclusions:

Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.

Keywords

triageinformation technologycomputerized decision supporttechnology implementation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 260 - 266
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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