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Simonson, Richard J., Joseph R. Keebler, Rosemarie Fernandez, Elizabeth H. Lazzara, and Alex Chaparro. "Over Triage: Injury Classification Mistake or Hindsight Bias?" Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 11, no. 1 (October 2022): 7–12. http://dx.doi.org/10.1177/2327857922111001.
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Patient triage is a critical stage in providing patients with the appropriate level of care required. Multiple metrics are considered in determining appropriate triage at the time of assessment. Due to the complexity of healthcare intervention, patients are often under- or over-triaged. Initiatives to reduce incorrect triages have been developed and implemented. These initiatives, however, may be based on hindsight bias and subsequently result in inaccurate assessments of triage accuracy and lead to improper triage-based education initiatives. This submission proposes the application of the SEIPS framework as a method of mitigating challenges introduced in the triage accuracy assessments due to this potential hindsight bias.
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Ure, Andrew. "Investigating the effectiveness of virtual treatment via telephone triage in a New Zealand general practice." Journal of Primary Health Care 14, no. 1 (March 3, 2022): 21–28. http://dx.doi.org/10.1071/hc21125.
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Introduction Telemedicine, including telephone triage, is increasingly being used in New Zealand general practices. Telephone triage involves diverting requests for same-day healthcare to a phone system where presenting complaints are explored only sufficiently to identify the most appropriate management pathway. Aim To assess the rates of repeat triage among general practice patients treated virtually via phone and compare these with outcomes for patients who were dealt with in person. Method 6 weeks of clinical telephone triage data were collected for Gore Medical Centre. Comparisons were made for patients treated virtually or in person, for whether complaints were a respiratory issue or not, and for whether their triage represented incomplete resolution of a previously triaged health complaint. To do this, patient notes for the 7 days prior to the phone triage were reviewed for medical consultations related to the same condition. Results Over 6 weeks, 455 telephone triages took place at the Gore Medical Centre: 133 triage phone calls resulted in 132 (29%) patients being treated virtually. Over the 6 study weeks, 19 virtually treated triage patients phoned again for further care of the same problem within 7 days (14%) while 23 patients (7%) who had been triaged to in person assessment also sought further care within 7 days. This difference was statistically significant (P < 0.05). There was no statistical difference in re-triage rates between Māori and non-Māori. Young age was a significant predictor for likelihood of re-triage. Discussion Virtual treatment via telephone triage at Gore Medical Centre resulted in a statistically increased likelihood of re-triage within 7 days compared with in person treatment. This raises questions about the efficacy of virtual treatment via telemedicine compared with in person treatment after triage.
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Kumar, R., S. Bhoi, S. Chauhan, T. P. Sinha, G. Adhikari, G. Sharma, and K. Shyamla. "(A264) Does the Implementation of Start Triage Criteria in the Emergency Department Reduce Over- and under-Triage of Patients?" Prehospital and Disaster Medicine 26, S1 (May 2011): s72—s73. http://dx.doi.org/10.1017/s1049023x11002482.
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BackgroundAppropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.MethodsThe study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.ResultsOf 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.ConclusionsThe START triage criteria reduce over- and under-triage of patients.
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Styrwoldt, E. "(P1-37) Over and Undertriage in Simulation Exercises." Prehospital and Disaster Medicine 26, S1 (May 2011): s110. http://dx.doi.org/10.1017/s1049023x11003694.
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Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.Material and Method76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.ResultsOf the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.ConclusionsTriage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.
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Peng, Yang, and Hai Hu. "Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study." BMJ Open 11, no. 10 (October 2021): e051802. http://dx.doi.org/10.1136/bmjopen-2021-051802.
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ObjectiveThe use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.DesignData in the Huaxi Earthquake Casualty Database were analysed retrospectively.SettingThis study was conducted in China.ParticipantsData on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.Primary outcome measureThe receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.ResultsThe ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.ConclusionAll methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.
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Smart, David, Cecily Pollard, and Bryan Walpole. "Mental Health Triage in Emergency Medicine." Australian & New Zealand Journal of Psychiatry 33, no. 1 (February 1999): 57–66. http://dx.doi.org/10.1046/j.1440-1614.1999.00515.x.
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Objective: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. Method: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. Results: Afour-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health ‘did not waits’ showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. Conclusions: Asystematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.
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Hilmi, L. M., A. Heerboth, D. Anthony, C. Tedeschi, and S. Balsari. "(A167) Patient Tracking In Disaster Drills." Prehospital and Disaster Medicine 26, S1 (May 2011): s48. http://dx.doi.org/10.1017/s1049023x11001658.
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IntroductionDisaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.MethodsOver eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.ResultsThere was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.ConclusionsOur group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
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Westall, Christopher, Robert Spackman, Channa Vasanth Nadarajah, and Nicola Trepte. "Are hospital admissions reduced by Acute Medicine consultant telephone triage of medical referrals?" Acute Medicine Journal 14, no. 1 (January 1, 2015): 10–13. http://dx.doi.org/10.52964/amja.0405.
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The NHS in England is facing well-documented pressures related to increasing acute hospital admissions at a time when the acute medical bed-base is shrinking, doctors working patterns are increasingly fragmented and many acute hospital trusts are operating a financial deficit. Novel strategies are required to reduce pressure on the acute medical take. We conducted a prospective cohort study to assess the impact of acute medicine consultant triage of referrals to the acute medical take on the number of acute hospital admissions as compared to a historical control cohort. The introduction of an acute medicine consultant telephone triage service was associated with a 21% reduction in acute medical admissions during whole the study period. True admission avoidance was achieved for 28.5% of referrals triaged by an acute medicine consultant. The greatest benefit was seen for consultant-triage of GP referrals; 43% of all GP referrals resulted in a decision not to admit and in 25% the referral was avoided by giving advice alone. Consultant telephone triage of referrals to the acute medical take substantially reduces the number of acute medical admissions as compared to triage by a trained band 6 or higher nurse coordinator. Our service is cost effective and can be job-planned using 6 full-time equivalent acute medicine consultants. The telephone triage service also provides additional benefits to admission numbers beyond its hours of operation and the general management of the acute medical take.
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Tanner, Richard, Eugene Cassidy, and Iomhar O’Sullivan. "Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm." Advances in Emergency Medicine 2014 (September 3, 2014): 1–9. http://dx.doi.org/10.1155/2014/492102.
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Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses (n=49) were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, P<0.001. The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, P<0.001).
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McCourt, Jacita A., Eli Strait, and Jeanne Lee. "583 Photos of Burn Wounds Can Help Reduce Over-Triage and Prevent Unnecessary Ambulance Transfer." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S128—S129. http://dx.doi.org/10.1093/jbcr/irac012.211.
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Abstract Introduction Burn wounds can be difficult to assess for providers outside the burn center and can result in over triage. The combination of photos of burn wounds with a clinical history can help burn practitioners make appropriate triage decisions, including immediate ambulance transfer vs scheduling an outpatient follow up appointment. Appropriate photo triage can help reduce healthcare costs by eliminating both unnecessary transfers to the burn center and overburdening burn resources. This performance improvement project involved the development of a secure photo sharing web portal and photo triage clinical pathway to help burn practitioners appropriately triage burn patients being evaluated at health care facilities within the catchment area of an American Burn Association verified adult and pediatric burn center. Methods Existing technology was used to develop a burn photo sharing web portal that can be easily accessed by providers outside the burn center. A new clinical pathway for burn photo triage was developed. Education was formulated for nurses and providers within the burn center and for referring facilities. Retrospective data was collected for the 4 years of ambulance transfers captured in the outpatient burn registry prior to the implementation of the photo triage clinical pathway. Comparison data was also abstracted for the first year after implementation. Patients were categorized as over triaged or appropriately triage based on the first set of photos captured in the EMR. Results In the pre-triage years there were a total of 242 ambulance transfers to the outpatient burn clinic. 150 (62%) of those patients were appropriately triaged, while 92 (38%) were over triaged. In the year following implementation there were 27 ambulance transfers to the outpatient burn clinic. 25 (92.6%) of these patients were appropriately triaged while 2 (7.4%) were over triaged. Overall ambulance transfers to the outpatient burn clinic dropped by more than 50% (average of 60.5 transfer per year down to 27 after implementation). Conclusions Patients with burn injuries at referring facilities were more appropriately triaged when using photos of wounds which ultimately reduced the number of unnecessary ambulance transfers.
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Lya Fitriyani, Saldy Yusuf, and Kusrini S. Kadar. "SISTEM TRIASE ONLINE DALAM PERAWATAN LUKA SELAMA PANDEMI COVID-19: LITERATUR REVIEW." Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing) 8, no. 4 (October 31, 2022): 628–41. http://dx.doi.org/10.33023/jikep.v8i4.1210.
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ABSTRAK
Pendahuluan: Perawatan luka adalah aspek penting yang harus terus dilakukan selama COVID-19. Solusi yang bisa dilakukan adalah Triage. Triase dalam perawatan luka bertujuan menentukan tingkat kedaruratan luka sebagai langkah awal pengambilan keputusan klinis. Tinjauan pustaka ini bertujuan untuk mengkaji penerapan sistem triase online dalam perawatan luka selama COVID-19. Metode: Tinjauan Literatur ini dilakukan dengan mencari artikel di database PubMed, ProQuest, Cochrane Library. Hasil: Sembilan penelitian termasuk kriteria inklusi. Sebuah studi menunjukkan bahwa triase online memiliki dampak positif pada penyembuhan luka 78,4% jika dibandingkan dengan kunjungan langsung 76,0% (p = 0,318). Penggunaan triase berdasarkan jenis luka dan penyakit penyerta pada Ulkus Kaki Diabetik menunjukkan hasil yang positif bahwa 41 (31,8%) pasien sembuh, 3 (1,9%) mengalami amputasi berat, 3 (1,9%) meninggal, 1 (0,7%) positif COVID-19. Indikator yang digunakan sebagai acuan dalam triase adalah pemeriksaan suhu tubuh, CT-Scan dada, pemeriksaan darah, usap nasofaring, penyakit penyerta, dan gambaran luka. Selain itu, empat penelitian menunjukkan beberapa penggunaan media online yang dapat memfasilitasi triase antara lain WhatsApp, mHealth, telehealth. Diskusi: Sistem triase online dapat diterapkan melalui berbagai cara antara lain mengirim foto atau video, melalui pesan teks, video call. penerapan triase luka dapat meminimalkan risiko kontaminasi dengan area berisiko tinggi COVID-19.
Kata kunci: COVID-19, Perawatan Luka, Triase Online,
ABSTRACT
Background: Wound care is important aspect that must be continue during COVID-19. One solution that can be done is Triage. This literature review aims to examine the application of online triage systems in wound care during COVID-19. Method: Current Literature review was conducted by searching for articles in the PubMed, ProQuest, and Cochrane Library databases. Result: Nine studies including of inclusion criteria. One study confirmed that online triage had a positive impact on wound healing 78.4% when compared to in-person visits 76.0% (p = 0.318). Use of triage based on the type of wound and comorbidities on Diabetic Foot Ulcer showed a positive result, 41 (31.8%) patients recovered, 3 (1.9%) had major amputations, 3 (1.9%) died, 1 (0.7%) positive for COVID-19. Indicators used as a reference in triage are body temperature checks, chest CT-Scan, blood tests, nasopharyngeal swabs, comorbid diseases, and wound features. In addition, four studies report various platform, including; WhatsApp, mHealth, and Telehealth. Discussion: the online triage system can be applied through various methods including sending photos or videos, via text messages, video calls. The application of wound triage can minimize the risk of contamination with highrisk areas COVID-19.
Keyword: COVID-19, Online Triage, Wound Care
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Graversen, Dennis Schou, Linda Huibers, Morten Bondo Christensen, Flemming Bro, Helle Collatz Christensen, Claus Høstrup Vestergaard, and Anette Fischer Pedersen. "Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark." BMJ Open 10, no. 3 (March 2020): e033528. http://dx.doi.org/10.1136/bmjopen-2019-033528.
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ObjectivesTo compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage.DesignNatural quasi-experimental cross-sectional study.SettingTwo Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.Participants1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441).Main outcome measuresTwenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call.ResultsThe risk ofpoorquality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding ‘allowing the caller to describe the situation’ (GP: 13.5% nurse: 9.8%), ‘mastering questioning techniques’ (GP: 27.4% nurse: 21.1%), ‘summarising’ (GP: 33.0% nurse: 21.0%) and ‘paying attention to caller’s experience’ (GP: 25.7% nurse: 17.0%). The risk ofpoorquality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items.ConclusionsCompared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.
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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO70: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 20, S1 (May 2018): S31—S32. http://dx.doi.org/10.1017/cem.2018.132.
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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, ED funding and workload models. The Electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes the application of national triage guidelines (CTAS) across Ontario. The objective of this study was to evaluate the implementation of eCTAS in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1200 (738 pre-eCTAS, 462 post-implementation) individual patient CTAS assessments were audited over 33 (21 pre-eCTAS, 11 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients pre-eCTAS, compared to 429 (93.0%) patients triaged with eCTAS. Using the auditors CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.1% vs. 3.2%; 8.9, 95% CI: 5.7, 11.7) and under-triaged (12.9% vs. 3.9%; 9.0, 95% CI: 5.9, 12.0). Interrater agreement was higher with eCTAS (unweighted kappa 0.90 vs 0.63; quadratic-weighted kappa 0.79 vs. 0.94). Research assistants captured triage time for 4403 patients pre-eCTAS and 1849 post implementation of eCTAS. Median triage time was 304 seconds pre-eCTAS and 329 seconds with eCTAS ( 25 seconds, 95% CI: 18, 32 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
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Zhang, David, Bradley Shy, and Nicholas Genes. "Early Rooming Triage: Accuracy and Demographic Factors Associated with Clinical Acuity." Western Journal of Emergency Medicine 23, no. 2 (February 28, 2022): 145–51. http://dx.doi.org/10.5811/westjem.2021.12.53873.
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Introduction: Early rooming triage increases patient throughput and satisfaction by rapidly assigning patients to a definitive care area, without using vital signs or detailed chart review. Despite these operational benefits, the clinical accuracy of early rooming triage is not well known. We sought to measure the accuracy of early rooming triage and uncover additional patient characteristics that can assist triage. Methods: We conducted a single-center, retrospective population study of walk-in emergency department (ED) patients presenting to the ED via an early rooming triage system, examining triage accuracy and demographic factor correlation with higher acuity ED outcomes. Results: Among all patients included from the three-year study period (N = 238,457), early rooming triage was highly sensitive (0.89) and less specific (0.61) for predicting which patients would have a severe outcome in the ED. Patients triaged to the lowest acuity area of the ED experienced severe outcomes in 4.39% of cases, while patients triaged to the highest acuity area of the ED experienced severe outcomes in 65.9% of cases. An age of greater than 43 years (odds ratio [OR] 3.48, 95% confidence interval: 3.40, 3.57) or patient’s home address farther from the ED ([OR] 2.23 to 3.08) were highly correlated with severe outcomes. Multivariable models incorporating triage team judgment were robust for predicting severe outcomes at triage, with an area under the receiver operating characteristic of 0.82. Conclusion: Early rooming workflows are appropriately sensitive for ED triage. Consideration of demographic factors, automated or otherwise, can augment ED processes to provide optimal triage.
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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO81: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 21, S1 (May 2019): S37. http://dx.doi.org/10.1017/cem.2019.123.
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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, emergency department (ED) funding and workload models. The electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes that application of national triage guidelines across Ontario. The objective of this study was to evaluate triage times and score agreement in ED settings where eCTAS has been implemented. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1491 (752 pre-eCTAS, 739 post-implementation) individual patient CTAS assessments were audited over 42 (21 pre-eCTAS, 21 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 567 (75.4%) patients pre-eCTAS, compared to 685 (92.7%) patients triaged with eCTAS. Using the auditor's CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.0% vs. 5.1%; Δ 6.9, 95% CI: 4.0, 9.7) and under-triaged (12.6% vs. 2.2%; Δ 10.4, 95% CI: 7.9, 13.2). Interrater agreement was higher with eCTAS (unweighted kappa 0.89 vs 0.63; quadratic-weighted kappa 0.91 vs. 0.71). Research assistants captured triage time for 3808 patients pre-eCTAS and 3489 post implementation of eCTAS. Median triage time was 312 seconds pre-eCTAS and 347 seconds with eCTAS (Δ 35 seconds, 95% CI: 29, 40 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
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Poon, Wai Kwong. "TRIAGE! TRIAGE!! TRIAGE!!! (NOT TREATMENT!!)." Prehospital and Disaster Medicine 14, S1 (March 1999): S96—S97. http://dx.doi.org/10.1017/s1049023x0003497x.
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Khorram- Manesh, A., A. Hedelin, and P. Ortenwall. "(A82) Triage in the Prehospital Setting." Prehospital and Disaster Medicine 26, S1 (May 2011): s23. http://dx.doi.org/10.1017/s1049023x11000872.
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IntroductionThe prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.AimThe aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.Method and MaterialOver 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.ResultsThere was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.Discussion and ConclusionsA mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
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Cuttance, Glen, Kathryn Dansie, and Tim Rayner. "Paramedic Application of a Triage Sieve: A Paper-Based Exercise." Prehospital and Disaster Medicine 32, no. 1 (December 14, 2016): 3–13. http://dx.doi.org/10.1017/s1049023x16001163.
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AbstractIntroductionTriage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area.ObjectiveThe goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates.MethodTwo hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire.ResultsThe study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups.ConclusionThis study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A “just-in-time” educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI.CuttanceG, DansieK, RaynerT. Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3–13.
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Betz, Martin, James Stempien, Sachin Trevidi, and Rhonda Bryce. "A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations." CJEM 19, no. 04 (December 5, 2016): 265–70. http://dx.doi.org/10.1017/cem.2016.398.
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ABSTRACT Objectives Emergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS). Methods This observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged. Participants’ CTAS scores were collected from the electronic record. Patients arriving to the ED by ambulance were excluded. Results A total of 536 participants were timed over 13 separate intervals. Of these, 11 left without being triaged. Participants who scored either CTAS 1 or 2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1) minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6, 24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, and CTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patients subsequently categorized as CTAS 1 or 2, 20.8% waited longer than the recommended time-to-physician of 15 minutes to be triaged. Conclusions All urban EDs closely follow patients’ wait times, often stratified according to triage category, which are assumed to be time-stamped upon a patient’s arrival in the ED. We note that pre-triage times exceed the CTAS recommended time-to-physician in a possibly significant proportion of patients. EDs should consider documenting times to treatment from the moment of patient arrival rather than registration.
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El Tawil, Chady, and Daniel Brody. "Pediatric Emergency Resident – Nurse Teaching: a Survey of an Innovative Method." Canadian Journal of Emergency Nursing 45, no. 3 (December 13, 2022): E6—E9. http://dx.doi.org/10.29173/cjen180.
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Background
Triage is one of the most important steps in the emergency department (ED), as it helps to recognize the urgency among patients. A proper triage system identifies the most critical patients regardless of the time of presentation. Triage nurses rarely can follow up on their triaged patients to verify the accuracy of their decision.
Methods
A teaching session on male genitalia triage by a Pediatric Emergency Medicine (PEM) resident was given to triage nurses and a survey was sent afterwards to all participants to evaluate the confidence in their triage accuracy before and after the session.
Results
The results showed a statistically significant increase in the confidence of nurses in avoiding both undertriage and overtriage accuracy. Also, all the nurses recommended attending similar talks given by a PEM resident. This study has helped in ameliorating interprofessional relationship between the nurses and residents especially with the increased use of masks. However, the number of nurses is too small to be representative and a bigger quality improvement study is needed.
Conclusion
PEM resident-nurses teaching is an innovative method to improve the accuracy and quality of triage and to help establish good interpersonal relationship skills in the pediatric ED. More studies are needed in the future to validate this technique so that it can be implemented for all presentations.
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Lin, Daren, and Andrew Worster. "Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale." CJEM 15, no. 06 (November 2013): 353–58. http://dx.doi.org/10.2310/8000.2013.130842.
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ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (κ) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.Results:Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was κ −0.9, (95% confidence interval [CI] 20.96 to 20.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.
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Stackhouse, S., G. Innes, and E. Grafstein. "LO62: Variability in triage performance for chest pain patients in two Canadian cities." CJEM 20, S1 (May 2018): S28—S29. http://dx.doi.org/10.1017/cem.2018.124.
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Introduction: CTAS triage acuity determinations are used to prioritize patients, describe illness acuity, and compare casemix across institutions. The latter functions assume reliable application in diverse settings, but no studies have evaluated this using actual triage data. Methods: This administrative database study included all patients with a triage complaint of chest pain (CP) in Vancouver (2012-16) and Calgary (2016). We stratified patients into high vs. non-high severity groups based on discharge diagnoses. High severity diagnoses included all patients with aortic pathology, ACS, shock or arrest states, as well as patients requiring admission because of pulmonary embolism, dysrhythmias, CHF, neurologic or respiratory conditions. We dichotomized patient triage assignments to high (CTAS 1,2) vs. low (3,4,5) acuity, then constructed 2x2 tables correlating CTAS acuity with disease severity. Main outcomes included the proportion of CP patients triaged to high acuity categories and CTAS sensitivity for high severity conditions. Results: We studied 97277 Vancouver and 18622 Calgary patients. Age (mean, 54.8 years), sex (53.5% male) and casemix distributions were similar between cities, although Calgary had more high severity conditions (15.0% v. 10.5%) and a higher admission rate (22.5% v. 21.4%). Calgary triage nurses placed more patients in high acuity triage categories (85.1% vs. 45.2%) and achieved higher sensitivity for severe illness (96.2% vs. 76.2%); however, they were less accurate (28.7% vs. 60.3%) and less specific (16.8% vs. 58.4%). The proportion of CP patients triaged into high acuity categories ranged from 79% to 87% across four Calgary hospitals and from 28% to 62% at five Vancouver hospitals. Conclusion: This study shows profoundly different triage categorization at different sites seeing similar patient populations. Triage nurses are taught to strive for high sensitivity, but there may be operational consequences if specificity drops too low and large numbers of non-severe patients are triaged into high acuity categories. It is not clear which approach is better but these data suggest CTAS should not be used to compare patient acuity or complexity across different hospitals or regions.
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Tavakoli, Nader, Saeed Abbasi, and Afrooz Tayebi. "Concordance of triage performed with emergency severity index in the emergency departments of Rasoul Akram and Haft Tir hospitals." Journal of Preventive Epidemiology 5, no. 1 (October 29, 2020): e11-e11. http://dx.doi.org/10.34172/jpe.2020.11.
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Introduction: Triage is prioritizing patients by disease severity in the shortest possible time. Proper triage increases the quality of patient care services, increases patient’s satisfaction, decreases patient waiting time, decreases mortality, and enhances emergency department efficiency. Objectives: The aim of this study was to evaluate the concordance of triage performed by nurses with ESI standard, at Rasoul Akram and Haft Tir hospitals, which are the most important educational centers of Iran University of Medical Sciences. Patients and Methods: This is a cross-sectional design study done in 2019. The study population is patients referred to Rasoul Akram and Haft Tir hospitals. A sample of 800 patients was selected. In this study, we determined how triage level were determined and compared with triaging by emergency medicine assistant. Data were analyzed by SPSS 23. Results: Out of 800 samples, the highest triage level was related to level three (79.1%) and levels two, four and one were in the next levels. 13.5% of the cases were not properly triaged according to the ESI standard and the adaptation coefficient (kappa) between the triage level specified in the patient file with the emergency severity index (ESI) triage level between physician and nurse was 58%, which was a significant difference (P<0.001). The relationship between correct triage leveling and patients’ complaints was significant (P<0.001). Conclusion: Nurses triage education about appropriate triage and ESI tool should be one of the most urgent topics and priorities of the studied hospitals. Over triage causes resources wasted and under triage may harm the patient’s health.
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Allen, Casey J., Daniel J. Baldor, Carl I. Schulman, Louis R. Pizano, Alan S. Livingstone, and Nicholas Namias. "Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients." American Surgeon 83, no. 6 (June 2017): 648–52. http://dx.doi.org/10.1177/000313481708300632.
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Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.
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Khursheed, M., K. Ejaz, and F. Hanif. "(A261) Evolution of Triage Services in the Emergency Department Aga Khan University Hospital- Karachi." Prehospital and Disaster Medicine 26, S1 (May 2011): s72. http://dx.doi.org/10.1017/s1049023x11002457.
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The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.
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Sivapalan, S., M. Dale, C. Brown, and L. Colley. "Triage criteria in genitourinary medicine." International Journal of STD & AIDS 16, no. 9 (September 1, 2005): 630–32. http://dx.doi.org/10.1258/0956462054944543.
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McLeod, S. L., J. McCarron, K. Stein, S. Scott, H. J. Ovens, N. Mittman, and B. Borgundvaag. "LO75: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score in 7 emergency departments." CJEM 19, S1 (May 2017): S54. http://dx.doi.org/10.1017/cem.2017.137.
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Introduction: The Canadian Triage and Acuity Scale (CTAS) is the standard used in all Canadian (and many international) emergency departments (EDs) for establishing the priority by which patients should be assessed. In addition to its clinical utility, CTAS has become an important administrative metric used by governments to estimate patient care requirements, ED funding and workload models. Despite its importance, the process by which CTAS scores are derived is highly variable. Emphasis on ED wait times has also drawn attention to the length of time the triage process takes. The primary objective of this study was to determine the interrater agreement of CTAS in current clinical practice. The secondary objective was to determine the time it takes to triage in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 738 consecutive patient CTAS assessments were audited over 21 seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients. Using the auditor’s CTAS score as the reference standard, on-duty triage nurses over-triaged 89 (12.1%) and under-triaged 95 (12.9%) patients. Interrater agreement was “good” with an unweighted kappa of 0.63 (95% CI: 0.58, 0.67) and quadratic-weighted kappa of 0.79 (95% CI: 0.67, 0.90). Research assistants captured triage time for 3808 patients over 69 shifts at 7 different EDs. Median (IQR) triage time was 5.2 (3.8, 7.3) minutes and ranged from 3.9 (3.1, 4.8) minutes to 7.5 (5.8, 10.8) minutes. Conclusion: Variability in the accuracy, and length of time taken to perform CTAS assessments suggest that a standardized approach to performing CTAS assessments would improve both clinical decision making, and administrative data accuracy.
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Gravel, Jocelyn, Sergio Manzano, and Michael Arsenault. "Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale." CJEM 10, no. 01 (January 2008): 32–37. http://dx.doi.org/10.1017/s1481803500009982.
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ABSTRACT Objective: The Paediatric Canadian Triage and Acuity Scale (PaedCTAS) stipulates that febrile patients who are 3 to 36 months old should be triaged to the PaedCTAS 3 “urgent” category. To optimize resource use, we implemented a protocol enabling these children to be down-triaged to the PaedCTAS 4 “less urgent” category if there was no sign of toxicity. Our objective was to evaluate the safety of this triage protocol modification. Methods: This retrospective cohort study evaluated all patients triaged in an urban tertiary pediatric hospital during a 6-month period between November 22, 2005, and May 22, 2006. Data were retrieved from the emergency department (ED) database and rates of hospitalization and intensive care unit (ICU) admission were compared for 4 groups: all patients triaged as urgent (level 3), all febrile patients from 3 to 36 months old triaged as urgent (level 3), all patients triaged as less urgent (level 4) and all febrile patients aged 3 to 36 months old who were down-triaged to less urgent (level 4). Results: There were 36 285 total ED visits during the study period, including 3477 febrile children who were 3 to 36 months old. Nurses down-triaged 1869 febrile children (54%) to the level-4 (less urgent) category and left 1322 (38%) in the level-3 (urgent) category. Hospitalization rate for down-triaged febrile patients was similar to that seen for all PaedCTAS 4 patients (2.4% v. 2.8%, 95% confidence interval for difference –0.3% to 1.1%). Down-triaged patients had significantly lower admission rates than those remaining in the level-3 (urgent) category (absolute risk reduction 10.7% standard deviation 1.9%, p < 0.001). No down-triaged patient died or required ICU admission. Conclusion: Febrile children aged 6 to 36 months who have no signs of toxicity can safely be down-triaged, based on triage nurse clinical judgement, to the less urgent PaedCTAS 4 category. This modification would affect the triage level of approximately 5% of all pediatric ED visits.
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Kovacs, M., and S. Campbell. "LO31: Triage drift: Variation in application of the Canadian Triage Acuity Scale between triage nurses compared to triage paramedics in response to overcrowding pressures in an emergency department." CJEM 22, S1 (May 2020): S18. http://dx.doi.org/10.1017/cem.2020.87.
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Introduction: CTAS is a validated five-level triage score utilized in EDs across Canada and internationally. Moderate interrater reliability between prehospital paramedic and triage nurse application of CTAS during clinical practice has been found. This study is the first assessment of the variation in distribution of CTAS scores with increasing departmental pressure as measured by the NEDOCs scale comparing triage allocations made by triage nurses with those made by triage paramedics. Methods: We conducted a retrospective, observational cohort study of EDIS data of all patients triaged in the Halifax Infirmary Emergency Department from January 1, 2017-May 30, 2017 and January 1, 2018 - May 30, 2018. CTAS score assignment by nursing and paramedic triage staff were compared with increasing levels of ED overcrowding, as determined by the department NEDOCS score. Results: Nurses were more likely to assign higher acuity scores in all situations of department crowding; there was a 3% increased probability that a nurse, as compared to a paramedic, would triage as emergent when the ED was not overcrowded (Pearson chi-square(1) = 4.21, p < 0.05, Cramer's v = 0.028, n = 5314), and a 10% increased probability that a nurse, as compared to a paramedic, would triage a patient as emergent when EDs were overcrowded (Pearson chi-square(1) = 623.83, p < 0.001, Cramer's v = 0.11, n = 56 018). Conclusion: Increasing levels of ED overcrowding influence triage nurse CTAS score assignment towards higher acuity to a greater degree than scores assigned by triage paramedics.
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Sexton, Vanashree, Jeremy Dale, Carol Bryce, James Barry, Elizabeth Sellers, and Helen Atherton. "Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review." BMJ Open 12, no. 1 (January 2022): e051569. http://dx.doi.org/10.1136/bmjopen-2021-051569.
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ObjectiveTo evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.Eligibility criteria for selecting studiesStudies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care.Data extraction and synthesisTwo reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.ResultsThirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients’ adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions.ConclusionsFurther research is needed into patient level service use, including patients’ adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery.PROSPERO registration numberCRD42020178500.
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Hathorn, I. F., M. L. Barnes, and R. E. Mountain. "Nurse-led triage of otolaryngology out-patient referrals: an acceptable alternative?" Journal of Laryngology & Otology 123, no. 10 (July 2, 2009): 1160–62. http://dx.doi.org/10.1017/s0022215109990399.
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AbstractObjectives:To establish the safety and effectiveness of nurse-led triage of otolaryngology out-patient referrals.Method:One hundred consecutive general practitioner referrals were reviewed by two consultants, two specialist registrars, two foundation year two senior house officers and two otolaryngology nurses. One of the nurses had received triage training. All referrals were triaged as ‘urgent’, ‘soon’ or ‘routine’ by each rater.Results:The triage-trained nurse's results demonstrated good agreement with those of the senior consultant (80 per cent). This agreement was similar to that with the other consultant (77 per cent) and the specialist registrars (79 and 82 per cent). Weighted κ statistics (correcting for chance agreement) showed that the triage-trained nurse had the second closest agreement to the senior consultant (0.66). After the actual out-patient appointments, retrospective review of the patients' case notes revealed that none had been triaged inappropriately by the trained nurse, and no urgent cases had been missed.Conclusions:Triage of out-patient referrals by trained ENT nurses is safe and effective, and is an acceptable alternative to traditional consultant vetting of referrals.
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Cicero, Mark X., Marc A. Auerbach, Jason Zigmont, Antonio Riera, Kevin Ching, and Carl R. Baum. "Simulation Training with Structured Debriefing Improves Residents’ Pediatric Disaster Triage Performance." Prehospital and Disaster Medicine 27, no. 3 (June 2012): 239–44. http://dx.doi.org/10.1017/s1049023x12000775.
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AbstractIntroductionPediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners’ acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.MethodsA 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.ResultsA total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001).Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.ConclusionsStructured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.Cicero MX, Auerbach MA, Zigmont J, Riera A, Ching K, Baum CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):1-6.
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Feit, Norman. "To Triage or Not Triage?" Alternatives to the High Cost of Litigation 39, no. 3 (March 2021): 41–47. http://dx.doi.org/10.1002/alt.21882.
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Nickel, C. H., F. F. Grossmann, M. Christ, and R. Bingisser. "Triage: ESI oder Manchester Triage?" Medizinische Klinik - Intensivmedizin und Notfallmedizin 111, no. 2 (February 16, 2016): 134–35. http://dx.doi.org/10.1007/s00063-015-0132-x.
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Houston, Hamish, Gavin Deas, Shivam Naik, Kamal Shah, Shiras Patel, Maria Greca Dottori, Michael Tay, et al. "Utility of the FebriDx point-of-care assay in supporting a triage algorithm for medical admissions with possible COVID-19: an observational cohort study." BMJ Open 11, no. 8 (August 2021): e049179. http://dx.doi.org/10.1136/bmjopen-2021-049179.
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ObjectiveTo evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay.DesignRetrospective observational cohort.SettingLarge acute National Health Service hospital in London, UK.ParticipantsAll medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result.InterventionsMedical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19.Primary outcome measuresDiagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard.Results4.0% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46% (80/175) in those triaged as likely, 4.1% (50/1225) in possible and 0.3% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96% (95% CI 91% to 98%) and specificity of 61.5% (95% CI 59.8% to 63.1%), while the triage algorithm including FebriDx had sensitivity of 93% (95% CI 87% to 96%) and specificity of 86.4% (95% CI 85.2% to 87.5%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19.ConclusionsA triage algorithm including the FebriDx assay had good sensitivity and was useful to ‘rule-out’ COVID-19 among medical admissions to hospital.
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Alson, R. L. "(A258) Is It S.M.A.R.T. To S.T.A.R.T. To S.A.L.T. M.A.S.S. Casualty Victims?" Prehospital and Disaster Medicine 26, S1 (May 2011): s71. http://dx.doi.org/10.1017/s1049023x11002421.
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Triage of disaster and trauma victims is challenging, especially when responders have limited resources and brief periods of time. Over-triage of victims results in the consumption of resources that would be better utilized on more critical patients, and under-triage can result in increased mortality and/or morbidity, as victims do not receive the appropriate care. In addition, the same patient may be triaged multiple times as they move through echelons of care. These different echelons may have different objectives in the triage process Over the years, multiple triage schemes have been proposed and used, both in exercises and real events. None of these schemes is based on well-defined research, due to the difficulty of carrying out a randomized control study in real events. There has been a concerted effort to apply research findings in a effort to more effectively use resources and thus, improve patient outcomes as well as apply information garnered from after action reports. This presentation reviews the current issues and state of triage for disasters and mass-casualty incidents, drawing on examples from prior events. The ultimate objective of this presentation is to help the responder to better understand the process of triage and apply it to their clinical practice, thereby delivering care in an effective and timely manner.
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Hong, MEd, J. J., Gerard Carroll, MD, and Rick Hong, MD. "Presence of undertriage and overtriage in simple triage and rapid treatment." American Journal of Disaster Medicine 12, no. 3 (July 1, 2017): 147–54. http://dx.doi.org/10.5055/ajdm.2017.0268.
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Objective: We evaluated the use of the Simple Triage and Rapid Treatment (START) method by Emergency Medical Services (EMS) and hypothesized that EMS can categorize patients using the START algorithm accurately.Design: Retrospective Chart Review.Setting: Inner-city Tertiary-Care Institutional Emergency Department (ED).Participants: Patients ≥ 18 years transported by EMS with a START color of Red, Yellow, or Green during the state triage tag exercise, October 9-15, 2011.Interventions: EMS assigned each patient a START triage tag. Chart review of the electronic EMS run sheets was performed by investigators to determine a START color.Main Outcome Measures: START triage colors were re-categorized as Red = 1, Yellow = 2, and Green = 3. The difference between the investigators’ color and EMS color were coded as: 0 for agreement in triage, -1 for undertriage by one category, -2 for undertriage by two categories, 1 for overtriage by one category, 2 for overtriage by two categories.Results: Of 224 participants, START triage colors were: Red = 7.1 percent, Yellow = 19.2 percent, Green = 73.7 percent. The mean difference in triage categories was 0.228 (95% CI: 0.114-0.311, p.001). 71.0 percent of patients were triaged to the same category, 5.8 percent undertriaged by one category, 0 percent undertriaged by two categories, 17.9 percent overtriaged by one category, and 5.4 percent overtriaged by two categories.Conclusion: EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.
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Bonney, Joseph, Maxwell Osei-Ampofo, and Ahmed Nuhu Zakaria. "Low-Cost Tabletop Simulation for Disaster Triage." Prehospital and Disaster Medicine 34, s1 (May 2019): s147. http://dx.doi.org/10.1017/s1049023x19003285.
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Introduction:Disaster Medicine training in most parts of the world is done in a practical manner to allow users to practice the skills of triage and resource allocation.Aim:To develop a low-cost tabletop simulation and measure its effectiveness from the user perspective.Methods:A modified Delphi approach was used in developing a low-cost tabletop simulation exercise. Simple playing cards were used as patients with specific vitals and injuries. Two Hundred trainees of the National Ambulance Service were used to test the exercise. All the participants had an equal chance to triage a patient and arrange transport to an appropriate facility.Results:All participants expressed their satisfaction in the design and implementation of the tabletop exercise. Over 90% showed interest in replicating the exercise in their respective setting due to the low-cost nature of the setup. During the exercise6. 0% of the patients were triaged correctly, while 80% were transported from the scene in an orderly manner. All the participants agreed on the useful and educational value of the exercise.Discussion:The use of a low-cost tabletop exercise in disaster medicine training is essential for low- and middle-income countries to promote education, and has been shown to be acceptable and feasible.
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Verma, Aikta, David J. Gladstone, Jiming Fang, Jordan Chenkin, Sandra E. Black, and P. Richard Verbeek. "Effect of online medical control on prehospital Code Stroke triage." CJEM 12, no. 02 (March 2010): 103–10. http://dx.doi.org/10.1017/s1481803500012124.
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ABSTRACT Objective: Prehospital Code Stroke triage has the potential to overwhelm stroke centres by falsely identifying patients as eligible for fibrinolysis. We sought to determine whether online medical control (whereby paramedics contact the medical control physician before a Code Stroke triage is assigned) reduced the proportion of false-positive Code Stroke patients. Methods: Following the introduction of a protocol for prehospital Code Stroke triage in an urban centre, online medical control alternated with off-line medical control (whereby paramedics implement Code Stroke triage independently) over 4 discreet intervals. We reviewed data for patients triaged to 3 regional stroke centres to compare the proportion of false-positive Code Stroke patients during online versus off-line medical control. We predefined false positives as patients triaged as Code Stroke who had symptoms discovered on awakening, were last seen in their usual state of health greater than 2 hours before assessment or had a final diagnosis other than stroke. Results: The proportion of false positives was lower during online medical control (31% v. 42%, p = 0.003). This was explained by a lower proportion of patients whose symptoms were discovered on awakening (8% v. 14%, p < 0.001) and who were last seen in their usual state of health greater than 2 hours before assessment (22% v. 32%, p = 0.005). A final diagnosis of stroke was similar in the 2 groups (77% v. 79%, p = 0.39), as was the proportion of patients receiving fibrinolysis (35% v. 33%, p = 0.72). Eighteen percent of patients were denied Code Stroke triage during online control, most commonly because of the time of symptom onset. Conclusion: Online medical control is associated with a reduced proportion of false-positive Code Stroke triage.
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Ng, Chip-Jin, Cheng-Yu Chien, Julian Chen-June Seak, Shang-Li Tsai, Yi-Ming Weng, Chung-Hsien Chaou, Chan-Wei Kuo, Jih-Chang Chen, and Kuang-Hung Hsu. "Validation of the five-tier Taiwan Triage and Acuity Scale for prehospital use by Emergency Medical Technicians." Emergency Medicine Journal 36, no. 8 (July 29, 2019): 472–78. http://dx.doi.org/10.1136/emermed-2018-207509.
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ObjectivesThis study aimed to determine the inter-rater reliability of the five-level Taiwan Triage and Acuity Scale (TTAS) when used by emergency medical technicians (EMTs) and triage registered nurses (TRNs). Furthermore, it sought to validate the prehospital TTAS scores according to ED hospitalisation rates and medical resource consumption.MethodsThis was a prospective observational study. After training in five-level triage, EMTs triaged patients arriving to the ED and agreement with the nurse triage (TRN) was assessed. Subsequently, these trained research EMTs rode along on ambulance calls and assigned TTAS scores for each patient at the scene, while the on-duty EMTs applied their standard two-tier prehospital triage scale and followed standard practice, blinded to the TTAS scores. The accuracy of the TTAS scores in the field for prediction of hospitalisation and medical resource consumption were analysed using logistic regression and a linear model, respectively, and compared with the accuracy of the current two-tier prehospital triage scale.ResultsAfter EMT’s underwent initial training in five-level TTAS, inter-rater agreement between EMTs and TRNs for triage of ED patients was very good (κw=0.825, CI 0.750 to 0.900). For the outcome of hospitalisation, TTAS five-level system (Akaike’s Information Criteria (AIC)=486, area under the curve (AUC)=0.75) showed better discrimination compared with TPTS two-level system (AIC=508, AUC=0.66). Triage assignments by the EMTs using the the five-level TTAS was linearly associated with hospitalisation and medical resource consumption.ConclusionsA five-level prehospital triage scale shows good inter-rater reliability and superior discrimination compared with the two-level system for prediction of hospitalisation and medical resource requirements.
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Singh, Gurdeep, and Sue McVerry. "Appropriateness of triage in genitourinary medicine." International Journal of STD & AIDS 17, no. 11 (November 2006): 786. http://dx.doi.org/10.1258/095646206778691158.
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Gravel, Jocelyn, Sergio Manzano, and Michael Arsenault. "Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital." CJEM 11, no. 01 (January 2009): 23–28. http://dx.doi.org/10.1017/s1481803500010885.
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ABSTRACTObjective:We evaluated the validity of the Canadian Paediatric Triage and Acuity Scale (Paed-CTAS) for children visiting a pediatric emergency department (ED).Methods:This was a retrospective study evaluating all children who presented to a pediatric university-affiliated ED during a 1-year period. Data were retrieved from the ED database. Information regarding triage and disposition was registered in an ED database by a clerk following patient management. In the absence of a gold standard for triage, admission to hospital, admission to pediatric intensive care unit (PICU) and length of stay (LOS) in the ED were used as surrogate markers of severity. The primary outcome measure was the correlation between triage level (from 1 to 5) and admission to hospital. The correlation between triage level and dichotomous outcomes was evaluated by aχ2test and an analysis of variance (ANOVA) was used to evaluate the association between triage level and ED LOS.Results:Over the 1-year period, 58 529 patients were triaged in the ED. The proportion admitted to hospital was 63% for resuscitation (level 1), 37% for emergent (level 2), 14% for urgent (level 3), 2% for semiurgent (level 4) and 1% for nonurgent (level 5) (p< 0.001). There was also a good correlation between triage levels and LOS and admission to PICU (bothp< 0.001).Conclusion:This computerized version of PaedCTAS demonstrates a strong association with admission to hospital, admission to PICU and LOS in the ED. These results suggest that PaedCTAS is a valid tool for triage of children in a pediatric ED.
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Dong, S. L. "Emergency Triage: Comparing a Novel Computer Triage Program with Standard Triage." Academic Emergency Medicine 12, no. 6 (June 1, 2005): 502–7. http://dx.doi.org/10.1197/j.aem.2005.01.005.
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Ashkenazi, Itamar, Boris Kessel, Tawfik Khashan, Jacob Haspel, Meir Oren, Oded Olsha, and Ricardo Alfici. "Precision of In-Hospital Triage in Mass-Casualty Incidents after Terror Attacks." Prehospital and Disaster Medicine 21, no. 01 (February 2006): 20–23. http://dx.doi.org/10.1017/s1049023x00003277.
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AbstractIntroduction:Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan.Objective:The objective of this study was to assess the precision of triage in mass-casualty incidents.Methods:The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS).Results:Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 ≤ISS<16), and 11 severe (ISS < 16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%).Conclusion:Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.
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Edwards, Martin. "Triage." Lancet 373, no. 9674 (May 2009): 1515. http://dx.doi.org/10.1016/s0140-6736(09)60843-6.
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Dallaire, Clémence, Julien Poitras, Karine Aubin, André Lavoie, Lynne Moore, and Geneviève Audet. "Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses." CJEM 12, no. 01 (January 2010): 45–49. http://dx.doi.org/10.1017/s148180350001201x.
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ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.
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McGlynn, Nicholas, Ilene Claudius, Amy H. Kaji, Emilia H. Fisher, Alaa Shaban, Mark X. Cicero, Genevieve Santillanes, Marianne Gausche-Hill, Todd P. Chang, and J. Joelle Donofrio-Odmann. "Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims." Prehospital and Disaster Medicine 35, no. 2 (February 14, 2020): 165–69. http://dx.doi.org/10.1017/s1049023x20000163.
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AbstractIntroduction:The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”Hypothesis/Problem:Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.Methods:A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.Results:A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.Conclusion:Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.
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Wythe, J. "Triage." BMJ Supportive & Palliative Care 1, no. 2 (September 1, 2011): 253. http://dx.doi.org/10.1136/bmjspcare-2011-000105.148.
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Christian, Michael D. "Triage." Critical Care Clinics 35, no. 4 (October 2019): 575–89. http://dx.doi.org/10.1016/j.ccc.2019.06.009.
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Fernandes, Christopher M. B., Shelley McLeod, Joel Krause, Amit Shah, Justine Jewell, Barbara Smith, and Lorraine Rollins. "Reliability of the Canadian Triage and Acuity Scale: interrater and intrarater agreement from a community and an academic emergency department." CJEM 15, no. 04 (July 2013): 227–32. http://dx.doi.org/10.2310/8000.2013.130943.
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ABSTRACTObjectives:The Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool that is used to help prioritize the order in which emergency department (ED) patients should be seen. The objectives of this study were to determine the interrater and intrarater agreement of the 2008 CTAS guideline revisions by triage nurses and to compare agreement between triage nurses working in a small community ED and an academic ED.Methods:Seventy-eight triage nurses assigned CTAS scores and free-text presenting complaints for 10 paper-based case scenarios. For five scenarios, the CTAS score should have remained unchanged from previous guidelines, whereas the other five scenarios should have been triaged differently based on the 2008 CTAS first-order modifiers. Thirty-three participants repeated the questionnaire 90 days later, and intrarater agreement was measured.Results:There was a higher level of agreement (κ = 0.73; 95% CI 0.68–0.79) for the five case scenarios, which relied on the older 2004 guidelines compared to the scenarios where the 2008 guidelines would have suggested a different triage level (κ = 0.50; 95% CI 0.42–0.59). For the 10 case scenarios analyzed, the free-text presenting complaints matched the Canadian Emergency Department Information System (CEDIS) list 90.1% of the time (κ = 0.80; 95% CI 0.76–0.84).Conclusion:The reliability of CTAS scoring by academic and community ED nurses was relatively good; however, the application of the 2008 CTAS revisions appears less reliable than the 2004 CTAS guidelines. These results may be useful to develop educational materials to strengthen reliability and validity for triage scoring using the 2008 CTAS guideline revisions.