Factors influencing the accuracy of triage by registered nurses in trauma patients

Abstract

An accuracy of triage in patients with trauma at the emergency department can assist them to receive appropriate treatment in time leading to decreased mortality and disability. The objectives of this study were to assess the accuracy of triage performed by registered nurses in the emergency department and examine factors influencing the triage accuracy in patients with trauma. A prospective observational design was performed in five emergency departments of regional hospitals in southern Thailand. The sample comprised 109 registered nurses and 1,090 adult patients with trauma. The accuracy of triage was calculated by using the difference score between the triage coding identified by a triage nurse immediately on patient emergency department arrival and the triage coding identified using the Emergency Severity Index Manual (Version 4). Multiple multinomial logistic regressions were employed to examine the predictors of triage accuracy. Only 52.4% of patients were categorized into an accurate triage group. Years of work by participants in the emergency department increased the likelihood of over-triage. In terms of patient characteristics, patients with blunt injury, multiple injuries and altered consciousness were more likely to be over triaged. These data provide strong evidence to support the implementation of the Emergency Severity Index version 4 as a standard tool in the emergency department during triage. Such a policy would contribute to improving the accuracy of the triage level designation in patients with trauma receiving service from an emergency department.