Evaluation of nurse-physician inter-observer agreement on triage categorization in the emergency department of a Taiwan medical center.

BACKGROUND To examine nurse-physician inter-observer agreement on triage categorization and analyze their differences for future reference. METHODS A retrospective observational study was performed. Patients entering a 3500-bed medical center emergency department (ED) from July 1 to 31, 1998 were randomly selected. We compared triage assignments made by nurses and 2 ED physicians, and examined them for inter-observer agreement (kappa-statistic) within each illness category. RESULTS We found that the overall nurse-physician agreement on triage categorization had a kappa-value of 0.32 (99% confidence interval, 0.27-0.37). The level of inter-observer agreement was not consistent across all illness categories. Agreement was better when assigning critical patients, but it was poor when assigning non-emergency patients. CONCLUSION The overall nurse-physician agreement with triage categorization was poor. The lack of agreement on triage decision making has important implications for EDs in which the priority of care is based on nursing triage categorization. Detailed chart recording and continued work is necessary to improve the agreement between nurse-physician triage categorization.