Jordi Karin, Grossmann Florian, Gaddis Gary M, Cignacco Eva, Denhaerynck Kris, Schwendimann René, Nickel Christian H
Institute of Nursing Science, University of Basel, Basel, Switzerland.
Department of practice development, Hospitals of Canton Solothurn, Olten, Switzerland.
Scand J Trauma Resusc Emerg Med. 2015 Aug 28;23:62. doi: 10.1186/s13049-015-0142-y.
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.
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.
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.
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.
急诊严重程度指数（ESI）是一种用于急诊科患者分诊的英文工具。经过翻译后，越来越多非英语国家的急诊科开始采用该工具对患者进行分诊。目前关于分诊护士进行ESI评分能力的报告较少。我们旨在确定四家医院的分诊护士根据标准化的ESI情景确定ESI的准确性、评分者间信度和主观信心。
分诊护士为30个标准的ESI（《ESI实施手册第4版》）翻译教学病例情景中的每一个分配一个ESI分数。测量ESI评分的准确性和评分者间信度（Krippendorff's alpha）。护士应用ESI算法的主观信心通过李克特量表获得。
来自四个急诊科的69名护士参与了该研究。他们对59.6%的病例情景评分正确。评分者间信度为0.78（Krippendorff's alpha）。大多数（54/69，78%）护士对自己应用ESI的能力有信心。
当护士对30个翻译成母语的标准书面病例情景进行ESI评分时，观察到ESI评分分配的准确性较低，尽管评分者间信度良好且护士对自己应用ESI的能力有较高信心。虽然可行，但使用标准书面病例情景来确定ESI分诊评分有效性可能不是评估护士分诊技能的最佳方法。
