• Sara C Wireklint, Carina Elmqvist, Nicola Parenti, and Katarina E Göransson.
• Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden; Emergency Department, Region Kronoberg, Växjö, Sweden. Electronic address: sara.wireklint@kronoberg.se.
• Int Emerg Nurs. 2018 May 1; 38: 21-28.

BackgroundFrom a patient safety perspective, it is of great importance that decision support systems such as triage scales are evidence based. In the most recent national survey, the majority of Swedish Emergency Departments (EDs) apply the Swedish triage scale known as the Medical Emergency Triage Treatment Scale (METTS), subsequently renamed the Rapid Emergency Triage Treatment Scale (RETTS©). Despite national widespread implementation, there has been limited research on METTS/RETTS©.AimTo determine the reliability of application by registered nurses of the RETTS© triage scale in two Swedish emergency departments.MethodsIn this prospective, cross-sectional study at two EDs, 46 written patient scenarios were triaged by 28 registered nurses (RNs). Data were analysed with descriptive statistics and Fleiss kappa (κ).ResultsThe RNs allocated 1281 final triage levels. There was concordance in seven (15%) of the scenarios, and dispersion over two or more triage levels in 39 (85%). Dispersion across the stable/unstable patient boundary was found in 21 (46%) scenarios. Fleiss κ was 0.562, i.e. moderate agreement.ConclusionThe inability of the triage scale to distinguish between stable/unstable patients can lead to serious consequences from a patient safety perspective. No general pattern regarding concordance or dispersion was found.Copyright © 2017 Elsevier Ltd. All rights reserved.

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