The measurement of rural, remote and outpost triage nurse decisions in the Western Australian Country Health Service - Goldfields Region

Introduction: Triage is an autonomous nursing role, undertaken in the Emergency Department and involves the process of clinical assessment in order to determine the distribution of resources to patients. Background: Several studies have examined the consistency of triage in a mix of metropolitan and country health sites around Australia. No study has measured the consistency of triage in an area as geographically remote as the Western Australian Country Health Service Goldfields Region. Aim: The aim of this research was to measure the accuracy and consistency of triage nurse decisionmaking in one Western Australian Country Health Region and determine if health site or demographic data impact triage decisions. Methods: Triage scenarios previously validated through research by LeVasseur et al. (2001a) were utilised. The sample selection was purposive, secondary to the need to recruit from a specific nursing populace. An invitation to participate was sent through a third party and ensured confidentiality. The method of data collection was limited to an online questionnaire that focused on demographic data and triage scenarios. Data analysis included the use of SPSS software and descriptive analytic techniques. Overall triage consistency was measured using Fleiss' kappa coefficient. Results: There was no significant difference in the consistency of decision-making in paediatric and adult scenarios. The accuracy of participants triage decision-making decreased with each less urgent triage category. Post-graduate qualifications had no bearing on triage consistency. Overall inter-rater agreement, using Fleiss' kappa coefficient, was 0.44. This represents a fair-to-good level of interrater agreement. Conclusion: A framework needs to exist that defines acceptable error rates in triage decisionmaking. It is recommended that performance indicator thresholds be adapted as acceptable frequencies of triage inter-rater agreement. Fleiss' kappa should be adopted as a nationally accepted descriptor to enable the quantification of triage consistency. The Goldfields' triage nurses need to complete the ETEK and participate in annual triage self-auditing.