• Journal of Korean Critical Care Nursing
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• v.5 no.2
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• pp.61-71
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• 2012

Purpose: The aim of this study was to measure the inter-rater reliability of Emergency severity index (ESI) version 4 among triage nurse. Methods: This study was carried out from August 11, 2010 to September 7, 2010 in a regional emergency department. Data collection was done by ten triage nurses who trained ESI v.4. Two research nurses and ten triage nurses scored the ESI version 4 to the patients as references, independently. We calculated the weighted kappa between the triage nurses and research nurses to evaluate the consistency of the ESI v.4. Results: A total of 233 patients were enrolled in this study. Classification of ESI level was as follows - level 1 (0.4%), level 2 (21.0%), level 3 (67.8%), level 4 (9.4%), and level 5 (1.3%). Inter-rater reliability by weighted kappa was 0.79 (95% Confidence Interval= 0.74-0.83) and agreement rate was 87.1%. Under-triage rate by triage nurse was 6.0% and over-triage rate was 6.9%. Conclusion: For this study, inter-rater reliability was measured good level between triage nurses and research nurses in Korean single ED.

• Journal of Korean Clinical Nursing Research
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• v.26 no.1
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• pp.107-116
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• 2020

Purpose: This study was a prospective survey to evaluate the Korean Triage and Acuity Scale (KTAS) inter-rater reliability and to identify discordant areas in the KTAS classification between nurses and paramedics in emergency department (ED). Methods: Inter-rater reliability were evaluated using triage deta from January 11 to May 31, 2019. A convinience sample of a total of 800 patients who visited an emergnecy medical center in Incheon (400 adult and 400 pediatric patients in this study) were selected. The triages of this study a pair of one nurse and one paramedic performed triage at the same time, using the KTAS, Inter-rater reliability for the KTAS was evaluated with the weighted kappa. Results: The inter-rater reliability of the KTAS evaluated by weighted Kappa between nurse-paramedic KTAS score of adult patients was .71, and .66 for pediatric patients. Both were in the level considered as substantial. Among causes of triage discordance, the most frequently identified discordant item in triaging adults was the difference in the measurement of pain intensity (28.0%). For both adult and pediatric patients, multiple chief complaint was identified as the major discordant factor. In triaging pediatric patients the body temperature assessment by subjective judgments was the highest discordant item (50.7%). Conclusion: The study result suggested that the KTAS demonstrated a reasonable level of inter-rater reliability and functioned as a standardized triage tool for emergency medical services. In order to improve the inter-rater reliability and classification competence, it is necessary to revise the current all-integrated KTAS provider course to be differentiated for each job group.

• Journal of East-West Nursing Research
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• v.26 no.1
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• pp.91-99
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• 2020

Purpose: The study aims to assess the inter-rater reliability of the Korean Triage and Acuity Scale between the research nurses and the triage nurses. Methods: Interrater reliability was measured on 400 adult (≧15) and 400 pediatric (<15) patients who visited the emergency medical center from January 4 to June 30, 2018. Results: The study result showed that the inter-rater reliability of the Korean Triage and Acuity Scale was substantial, with κ=.73 (95% Confidence interval= .68-.78) and 77.0 percent agreement. The inter-rater of Pediatric Korean Triage and Acuity Scale was also substantial, with κ=.76 (95% Confidence interval= .71-.82) and 83.8 percent agreement. Conclusion: Although the inter-rater reliability of the Korean Triage and Acuity Scale was acceptable, the percent agreement was lower than the desirable level (<80.0%). It was confirmed that Pediatric Korean Triage and Acuity Scale had an acceptable level of inter-rater reliability and percent agreement for clinical use. Efforts should be made to improve the reliability in the future.

• Journal of Korean Critical Care Nursing
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• v.9 no.1
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• pp.15-26
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• 2016

Purpose: The aim of this study was to identify thinking strategies in the complicated decision-making process based on real patient-based data of triage nurses in the emergency department (ED). Methods: This study used the 'think aloud' method to collect data from 8 triage nurses from one general hospital ED in South Korea. The data were analyzed with protocol analysis using thinking strategies. Results: The triage process was divided into three stages. The first stage consisted of 8 thinking strategies, including searching for information. They used intuition based on directly observed concepts for identifying a crisis. The second stage consisted of 17 thinking strategies related to the decision-making process. They assessed patients and generated a hypothesis to try to understand their health problems through analytic thinking. The third stage consisted of 10 thinking strategies, including qualifying. They considered the situation of the ED and properly triaged the patients. During the triage process, they frequently used judging the value and searching for information on 17 thinking strategies. Conclusions: Triage nurses demonstrated various connected thinking strategies for each stage. Based on our results, further studies should be done to develop a triage education program.

• Journal of Korean Biological Nursing Science
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• v.24 no.2
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• pp.122-130
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• 2022

Purpose: This study was conducted to identify the professional competency of nurses working in emergency medical institutions that use the Korean Triage Acuity Scale (KTAS), and to identify factors that affect them. Methods: This study collected data from 105 nurses working in emergency medical institutions from June to August 2020. For data analysis, descriptive analysis, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression were performed using the SPSS 25.0 program. Results: As for the professional competency in triage, the higher the self-efficacy (β= 0.58, p< .001), the more experience they have in triage-related education (β= 0.30, p< .001), 2-4 years of clinical experience in emergency department (β= 0.19, p= .002), in case of triage alone (β= 0.24, p< .001), the higher the level of education a nurse has (β= 0.19, p= .003), the higher the professional competency in triage. These variables explained professional competency in a total of 64.2% of the participants (F = 38.30, p< .001). Conclusion: To improve nurses' professional competence in triage, introducing manpower expansion, financial support, and the provision of appropriate places is suggested. In addition, it is necessary to repeatedly provide educational opportunities in an environment similar to actual clinical practice by developing various scenarios and introducing simulations and web-based formats.

• The Korean Nurse
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• v.33 no.1
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• pp.30-36
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• 1994

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.11
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• pp.626-634
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• 2018

This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

• Journal of Korean Clinical Nursing Research
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• v.26 no.3
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• pp.395-406
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• 2020

Purpose: The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. Methods: The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. Results: Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. Conclusion: Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.4
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• pp.278-288
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• 2018

Purpose: Dehydration is a paediatric medical emergency but there is no single standard parameter to evaluate it at the emergency department. Our aim was to evaluate the reliability and validity of capillary refilling time as a triage parameter to assess dehydration in children. Methods: This was a prospective pilot cohort study of children who presented to two paediatric emergency departments in Italy, with symptoms of dehydration. Reliability was assessed by comparing the triage nurse's measurements with those obtained by the physician. Validity was demonstrated by using 6 parameters suggestive of dehydration. Comparison between refilling time (RT) and a validated Clinical Dehydration Score (CDS) was also considered. The scale's discriminative ability was evaluated for the outcome of starting intravenous rehydration therapy by using a receiver operating characteristic (ROC) curve. Results: Participants were 242 children. All nurses found easy to elicit the RT after being trained. Interobserver reliability was fair, with a Cohen's kappa of 0.56 (95% confidence interval [CI], 0.41 to 0.70). There was a significant correlation between RT and weight loss percentage (r-squared=-0.27; 95% CI, -0.47 to -0.04). The scale's discriminative ability yielded an area under the ROC curve (AUC) of 0.65 (95% CI, 0.57 to 0.73). We found a similarity between RT AUC and CDS-scale AUC matching the two ROC curves. Conclusion: The study showed that RT represents a fast and handy tool to recognize dehydrated children who need a prompt rehydration and may be introduced in the triage line-up.

• Research in Community and Public Health Nursing
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• v.30 no.4
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• pp.581-587
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• 2019

Purpose: Abdominal pain is the most common symptom of patients visiting the emergency department (ED). Abdominal pain is caused by a variety of causes, so it is difficult for a triage nurse to determine the urgency of a patient, but it is still a must. The purpose of this study was to identify the related factors to the urgent diseases of patients with abdominal pain visiting ED. Methods: This study was a retrospective descriptive study. The study setting was an ED in a tertiary hospital in Korea. Data were collected from September 1, 2017 to October 15, 2017. During the study period, of a total of 6,181 patients visiting the ED, 731 complained of abdominal pain. Patients with obvious cause of pain and patients who could not express detailed symptoms were excluded. The 573 patients were included in the final analysis. We collected demographics, clinical characteristics, and final diagnosis. We divided final diagnoses into urgent diseases which were more likely to be life-threatening without treatment and non-urgent diseases. We identified the related factors to the urgent diseases of patients with abdominal pain using the logistic regression. Results: 173 (30.2%) patients had urgent diseases. Age (OR=1.02, 95% CI=1.00~1.03), referral from other clinics (OR=2.92, 95% CI=1.86~4.60), ambulance utilization (OR=2.00, 95% CI=1.27~3.15), diarrhea (OR=0.44, 95% CI=0.25~0.76), and tachycardia (OR=2.27, 95% CI=1.44~3.58) were related to urgent diseases. Conclusion: Triage nurse should take into account the patient's age, mode of visiting, and route of visiting ED; and check the symptom of tachycardia or diarrhea.