Prognostic value of the reception, attendance and classification of patients in the emergency department of a tertiary hospital

Abstract

Background. The objective of this investigation is to study the usefulness, validity and reproducibility of the reception, attendance and classification of emergency cases employed by nurses in the emergency department of a tertiary hospital (Hospital de Navarra, Pamplona, Spain) (RACHN). Material and methods. By studying the proportion of emergencies classified according to our triage system (reception, attendance and classification [recepción, acogida y clasificación] at the Hospital de Navarra, RACHN), we carried out a transversal descriptive study between 3rd November and 17th November 2003 to evaluate the concordance between the level of severity assigned by a nurse using the RACHN triage system and that determined by a senior doctor. In addition, we evaluated the discrepancy between the degree of severity assigned by a nurse using the triage system and the level of severity determined by a senior doctor and that between the request for complementary tests by the nurse with the opinion of a senior doctor. Results. During the study period, 85.3% of the emergency cases were assigned severity levels using the 4 level scale RACHN triage system. The kappa index for severity assigned by the nurse was 0.76 (95%CI: 0.66-0.86) and that of the senior doctor, 0.71 (95% CI: 0.60-0.81). The discrepancy in severity was 26.1%. The request for complementary tests by the nurse proved correct in 95.2% of the cases, as determined by the senior doctor. Conclusion. The RACHN triage system depends primarily on the protocol established by the nurse that carries out triage. We have found a good degree of concordance between triage carried out by the nurse using the RACHN and that determined by the doctor. We believe the discrepancy can be reduced by establishing a five level scale of severity and by carrying out periodic reviews of the RACHN.