Triage accuracy and causes of mistriage using the Korean Triage and Acuity Scale

PurposeTo identify emergency department triage accuracy using the Korean Triage and Acuity Scale (KTAS) and evaluate the causes of mistriage.MethodsThis cross-sectional retrospective study was based on 1267 systematically selected records of adult patients admitted to two emergency departments between October 2016 and September 2017. Twenty-four variables were assessed, including chief complaints, vital signs according to the initial nursing records, and clinical outcomes. Three triage experts, a certified emergency nurse, a KTAS provider and instructor, and a nurse recommended based on excellent emergency department experience and competence determined the true KTAS. Triage accuracy was evaluated by inter-rater agreement between the expert and emergency nurse KTAS scores. The comments of the experts were analyzed to evaluate the cause of triage error. An independent sample t-test was conducted to compare the number of patient visits per hour in terms of the accuracy and inaccuracy of triage.ResultsInter-rater reliability between the emergency nurse and the true KTAS score was weighted kappa = .83 and Pearson’s r = .88 (p p = .442).ConclusionThere was highly agreement between the KTAS scores determined by emergency nurses and those determined by experts. The main cause of mistriage was misapplication of the pain scale to the KTAS algorithm.研究目的：采用韩国分诊与敏锐度量表（Korean Triage and Acuity Scale, KTAS）评估急诊科分诊准确性，并分析分诊失误的成因。 研究方法：本研究为横断面回顾性研究，纳入2016年10月至2017年9月间两家急诊科收治的1267例经系统筛选的成年患者病历资料。研究评估了24项变量，包括主诉、初始护理记录中的生命体征以及临床转归。由3名分诊专家确定真实KTAS评分，分别为1名认证急诊护士、1名KTAS认证提供者与培训讲师，以及1名凭借优秀急诊科工作经验与能力遴选的护士。通过急诊护士与专家的KTAS评分间的组间一致性评估分诊准确性，并分析专家意见以探讨分诊失误的成因。采用独立样本t检验，对比分诊准确组与失误组的每小时患者就诊量。 研究结果：急诊护士评分与真实KTAS评分的组间信度为加权kappa值=0.83，皮尔逊相关系数r=0.88（p=0.442）。 研究结论：急诊护士评定的KTAS评分与专家评定的评分间具有高度一致性。分诊失误的主要原因为将疼痛量表错误应用于KTAS算法。