• Arian Zaboli, Francesco Brigo, Alessandro Cipriano, Serena Sibilio, Gabriele Magnarelli, Norbert Pfeifer, Michele Fratti, Fabio Malalan, Magdalena Massar, Michael Mian, Nicola Pagnucci, Gloria Brigiari, Lorenzo Ghiadoni, and Gianni Turcato.
• Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), via A. Volta, 13°, Bolzano, Italy. zaboliarian@gmail.com.
• Intern Emerg Med. 2024 Aug 6.

BackgroundEmergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner.MethodsA multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes.ResultsEighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals.ConclusionThere is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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