Factors Influencing the Accuracy of Emergency Severity Index-Based Emergency Patient Triage
Keywords:
accuracy of emergency patient triage, emergency patients, Emergency Severity Index, triage nurses, training programme, patients’ age, comorbidity, emergency department experienceAbstract
Objective: To study how emergency department nurses’ experience and training, and patients’ age and comorbidity status, could influence the accuracy of emergency patient triage based on the Emergency Severity Index.
Design: Predictive correlational research.
Methodology: The participants were 78 triage nurses and 780 emergency patients at the emergency departments of seven tertiary hospitals affliated to the Ministry of Public Health and located in Bangkok Metropolitan Region. Five instruments were used to collect data: 1) a questionnaire on the triage nurses’ demographic data; 2) a questionnaire on the patients’ demographic data; 3) the Comorbidity Index by Charlson et al; 4) an outcome accuracy index; and 5) the Emergency Severity Index, version 4. Data were analysed using descriptive statistics and multinomial logistic regression analysis.
Results: The emergency nurses were found to perform emergency patient triage with 68.7% accuracy. Instances of overtriage were less frequently detected amongst nurses with 6 to 10 or more years of emergency department experience than amongst those with 1 to 5 years of emergency department experience (p < 0.01). Similarly, instances of undertriage were less frequent amongst nurses with 6 to 10 years of emergency department experience than amongst those with 1 to 5 years of emergency department experience (p < 0.01). In addition, undertriage was more frequent amongst the nurses who had passed a triage training programme than amongst those who had not (p < 0.01). The patients aged more
than 65 years were 2.43 times more likely to be undertriaged than those aged between 18 and
54 years (p < 0.05). Comorbidity, on the other hand, was not found to influence the accuracy of emergency patient triage based on the Emergency Severity Index.
Recommendations: Nurses appointed to the triage system should possess a minimum of 5 years’ emergency department experience and pass a standardised triage training programme, so as to minimise triage errors. Patients aged over 65 years need to be classifed according to medical procedure, and constantly monitored.
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