Poor agreement in application of the Australasian Triage Scale to paediatric emergency department presentations
Dianne J Crellin
Master of Nursing Candidate, School of Nursing, University of Melbourne; Clinical Nurse Educator, Department of Emergency Medicine, Royal Children's Hospital, Melbourne VIC
Linda Johnston
Associate Professor of Evidence Based Infant, Child and Adolescent Nursing, Royal Children's Hospital; University of Melbourne, VIC
PP: 048 - 060
Abstract
Background
The Australasian Triage Scale (ATS) is used in Australian emergency departments (ED) to describe patient priority on arrival. This study aimed to determine the level of inter-rater consistency with which the scale is applied to paediatric presentations. Additionally, it sought to document the level of certainty with which nurses apply the scale.
Method
An anonymous survey of emergency nurses responsible for paediatric triage decisions using written patient profiles.
Results
The level of agreement between nurses applying the ATS to paediatric presentations can be described as poor and appears lower than the consistency with which it is applied to adult presentations.
Conclusion
Inconsistent allocation of ATS category implies variable patient waiting times, which may have detrimental effects on patient condition. Hence, efforts must be made to address the inconsistency that exists in paediatric triage decision-making.
Keywords
triage; emergency nursing; paediatrics; interrater reliability
References
Aitken ME, Herrerias CT, Davis R, Bell HS, Coombs JB, Kleinman LC and Homer CJ (1998): Minor head injury in children: current management practices of pediatricians, emergency physicians, and family physicians. Archives of Pediatric and Adolescent Medicine 152(12): 1176-80.
Asch DA, Jedrziewski MK and Christakis NA (1997): Response rates to mail surveys published in medical journals. Journal of Clinical Epidemiology 50(10): 1129-36.
Australasian College of Emergency Medicine. (November 24, 2000): Guidelines for implementation of the Australasian Triage Scale in Emergency Departments. [ACEM website]. Available at: http://www.acem.org.au/open/documents/home.htm. Accessed May 29, 2002.
Baraff LJ (1991): Management of the febrile child: a survey of pediatric and emergency medicine residency directors. Pediatric Infectious Diseases Journal 10(10): 795-800.
Beveridge R, Ducharme J, Janes L, Beaulieu S and Walter S (1999): Reliability of the Canadian Emergency Department Triage and Acuity Scale: interrater agreement. Annals of Emergency Medicine 34(2): 155-9.
Browne GJ, Gaudry PL and Lam L (1997): A triage observation scale improves the reliability of the National Triage Scale. Emergency Medicine 9: 283-288.
Cole TJ, Thornton AJ, Green SJ and Morley CJ (1990): Field trials of Baby Check: a scoring system to quantify illness in babies under 6 months. Medical Informatics 15(3): 261-8.
Considine J, Ung L and Thomas S (2000): Triage nurses' decisions using the National Triage Scale for Australian emergency departments. Accident and Emergency Nursing 8(4): 201-209.
Considine J, Ung L and Thomas S (2001): Clinical Decisions using the National Triage Scale: how important is postgraduate education? Accident and Emergency Nursing 9: 101-108.
Crellin DJ and Johnston L (2002): Who is responsible for pediatric triage decisions in Australian emergency departments: a description of the educational and experiential preparation of general and pediatric emergency nurses. Pediatric Emergency Care 18(5): 382-8.
Cummings SM, Savitz LA and Konrad TR (2001): Reported response rates to mailed physician questionnaires. Health Services Research 35(6): 1347-55.
Dagan R, Powell KR, Hall CB and Menegus MA (1985): Identification of infants unlikely to have serious bacterial infection although hospitalised for suspected sepsis. Journal of Pediatrics 107(6): 855-860.
Dilley S and Standen P (1998): Victorian Nurses Demonstrate Concordance in the Application of the National Triage Scale. Emergency Medicine 10: 12-18.
Doherty S (1996): Application of the National Triage Scale is not uniform. Australian Emergency Nursing 1(26).
Durojaiye L and O'Meara M (2002): A study of triage of paediatric patients in Australia. Emergency Medicine 14(1): 67-76.
Fernandes CMB, Wuerz R, Clark S and Djurdjev O (1999): How reliable is emergency department triage? Annals of Emergency Medicine 34(2): 141-7.
Fredrickson JM, Bauer, Arellano D and Davidson M (1994): Emergency nurses' perceived knowledge and comfort regarding pediatric patients. Journal of Emergency Nursing 20(1): 13-7.
George S, Read S, Westlake L, Fraser-Moodie A, Pritty P and Williams B (1993): Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments. Journal of Epidemiology & Community Health 47(4): 312-5.
Gerdtz M and Bucknall T (2000): Australian triage nurses' decision-making and scope of practice. Australian Journal of Advanced Nursing 18(1): 24-33.
Glaser NS, Kuppermann N, Yee CK, Schwartz DL and Styne DM (1997):Variation in the management of pediatric diabetic ketoacidosis by specialty training. Archives of Pediatric and Adolescent Medicine 151(11): 1125-32.
Goodacre SW, Gillet M, Harris RD and Houlihan KPG (1999): Consistency of retrospective triage decisions as a standardised instrument for audit. Journal of Accident & Emergency Medicine 16(5): 322-4.
Haddon RA, Barnett PL, Grimwood K and Hogg GG (1999): Bacteraemia in febrile children presenting to a paediatric emergency department. Medical Journal of Australia 170(10): 475-8.
Hewson PH, Humphries SM, Roberton DM, McNamara JM and Robinson MJ (1990): Markers of serious illness in infants under 6 months old presenting to a children's hospital. Archives of Disease in Childhood 65: 750-756.
Holzemer WL, Schleutermann JA, Farrand LL and Miller AG (1981): A validation study: simulations as a measure of nurse practitioners' problem-solving skills. Nursing Research 30(3): 139-44.
Jelinek GA and Little M (1996): Inter-rater reliability of the National Triage Scale. Emergency Medicine 8: 226-230.
Jones RG and Bass JW (1993): Febrile children with no focus of infection: a survey of their management by primary care physicians. Pediatric Infectious Diseases Journal 12(3): 179-83.
Krauss BS, Harakal T and Fleisher GR (1991): The spectrum and frequency of illness presenting to a pediatric emergency department. Pediatric Emergency Care 7(2): 67-71.
Landis JR and Koch GG (1977): The measurement of observer agreement for categorical data. Biometrics 33: 159-174.
LeVasseur S, Considine J and Charles A (2001): Consistency of Triage in Victoria's Emergency Departments: Consistency of Triage Report. Monash Institute of Health Services Research Report to the Victorian Department of Health Services, Melbourne.
McCarthy PL, Lembo RM, Baron MA, Fink HD and Cicchetti DV (1985): Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children. Pediatrics 76(2): 167-71.
McMenamin C (1995): Making A&E less traumatic for children. Paediatric nurses in accident and emergency. Professional Nurse 10(5): 310-2.
Nelson DG, Leake J, Bradley J and Kuppermann N (1988): Evaluation of febrile children with petechial rashes: is there consensus among pediatricians? Pediatric Infectious Diseases Journal 17(12): 1135-40.
Nozicka CA (1998): Pediatric emergency medicine practice patterns: a comparison of pediatric and general emergency physicians. Pediatric Emergency Care 14(5): 382-3.
Peabody JW, Luck J, Glassman P, Dresselhaus TR and Lee M (2000): Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA 283(13): 1715-22.
Schweich PJ, Smith KM, Dowd MD and Walkley EI (1998): Pediatric emergency medicine practice patterns: a comparison of pediatric and general emergency physicians [see comments]. Pediatric Emergency Care 14(2): 89-94.
Selekman J and Malloy E (1995): Difficulties in symptom recognition in infants. Journal of Pediatric Nursing: Nursing Care of Children and Families 10(2): 89-92.
Shanon A and Feldman W (1994): Management of moderate head injury in childhood: degree of consensus among Canadian pediatric emergency physicians. Pediatric Emergency Care 10(6): 322-5.
Standen P and Dilley S (1997): A review of triage nursing practice and experience in Victorian public hospitals. Emergency Medicine 9: 301-5.
StataCorp (2001): Stata Statistical Software. Stata Corporation, College Station TX.
Taylor M and Soud T (1991): Florida pediatric emergency nursing education project. Journal of Emergency Nursing 17(3): 152-5; discussion 155.
Teach SJ and Fleisher GR (1995): Efficacy of an observation scale in detecting bacteremia in febrile children three to thirty-six months of age, treated as outpatients. Occult Bacteremia Study Group. Journal of Pediatrics 126(6): 877-81.
Watson S (2000): Children's nurses in the accident and emergency department: literature review. Accident & Emergency Nursing 8(2): 92-7.
Whitby S, Ieraci S, Johnson D and Mohsin M (1997): Analysis of the Process of Triage: The Use and Outcome of the National Triage Scale. Liverpool Health Service.
Wittler RR, Cain KK and Bass JW (1998): A survey about management of febrile children without source by primary care physicians. Pediatric Infectious Diseases Journal 17(4): 271-7; discussion 277-9.
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