Ekins Kylie, Morphet Julia
Emergency Department, Kalgoorlie Hospital, Western Australian Country Health Service, Australia; School of Nursing and Midwifery, Monash University, Australia.
School of Nursing and Midwifery, Monash University, Australia.
Australas Emerg Nurs J. 2015 Nov;18(4):227-33. doi: 10.1016/j.aenj.2015.05.002. Epub 2015 Jul 26.
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.
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.
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.
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.
澳大拉西亚分诊量表旨在确保所分配的分诊类别反映患者需要医疗救助的紧急程度。这取决于分诊护士决策的准确性。澳大拉西亚分诊量表还旨在促进个人和组织之间分诊决策的一致性。澳大利亚各地的多项研究探讨了分诊决策的准确性和一致性，但尚无研究专门关注农村卫生服务中的分诊决策。此外，尚未确定用于衡量准确性或一致性的标准。澳大利亚急诊科是根据一套标准绩效指标进行评估的，包括从分诊到患者评估的时间以及患者住院时间。目前没有分诊一致性的绩效指标。
设计了一份在线问卷，以收集人口统计学数据并衡量分诊的准确性和一致性。该问卷采用了先前经过验证的分诊场景。（1）测量分诊决策准确性，并使用Fleiss' kappa系数按卫生机构类型比较一致性。
46名分诊护士参与了本研究。参与者分诊决策的准确性随着分诊类别紧迫性的降低而下降。研究生学历与分诊准确性无关。儿科和成人场景之间的决策一致性没有显著差异。使用Fleiss' kappa系数得出的总体评分者间一致性为0.4。这代表了评分者间一致性处于中等偏上水平。
需要对分诊护士决策的准确性和一致性进行标准定义。不准确的分诊决策可能导致发病率和死亡率上升。建议将急诊科绩效指标阈值用作全国分诊一致性的基准。
