• Beng Leong Lim, Xing Mei Liew, Alicia Vasu, and Kim Chai Chan.
• Tan Tock Seng Hospital, Emergency Department, Singapore. Electronic address: Beng_Leong_Lim@ttsh.com.sg.
• Int Emerg Nurs. 2014 Oct 1; 22 (4): 208-13.

ObjectivesThis study investigated the inter-observer agreement (IOA) between doctors and nurses on triaging adult ED dyspneic patients.MethodsThis was a prospective observational study comparing eight trained ED nurses with doctors. Each patient was assessed by a nurse and two doctors (1 and 2) who decided on four-point Patient Acuity Category (PAC) and triage management steps. The primary outcome was the proportion of resuscitation room escalations from consult. Secondary outcomes included proportions and IOA of assigned PAC and steps in triage management. The investigators reported IOA as the k statistic (95% CIs) and percent agreement.Data/ResultsThere were 22/302 (7.3%) escalations; one from clinical deterioration. Proportions of assigned PAC status by nurses, Drs 1 and 2 were: PAC 1: 20.2-24.2%; PAC 2: 71.5-72.8%; PAC 3: 4.3-7.0%; PAC 4: 0.0-0.7%. The IOA was at least fair to moderate [k: 0.33 (0.22-0.43) to 1.00] in all steps of management except for electrocardiogram [k: 0.19 (0.10-0.27) to 0.45 (0.35-0.55)] ordering. The percent agreement ranged from 81 to 100% for all management steps except for chest Xray (66-73%) and electrocardiogram (61-71%) ordering.ConclusionTrained ED nurses were safe and managed adult dyspneic patients as well as doctors at triage.Copyright © 2014 Elsevier Ltd. All rights reserved.

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