Nurse-Physician Agreement on Triage Category: A Reliability Analysis of Emergency Severity Index

Background and Objectives: MThe Emergency Severity Index (ESI) triage is commonly used in clinical settings to determine the patients’ emergency severity. However, the reliability of this index is not sufficiently explored. The present study examines the inter-rater reliability of ESI by comparing triage ratings as performed by nurses and physicians. Methods: This prospective cross-sectional study was performed in Imam Reza Hospital in Tabriz, Iran. The stratification of 588 patients by the triage nurses were compared with that by the physicians. Cohen's un-weighted Kappa, and linear-weighted Kappa, and quadratic-weighted Kappa were used to quantify the agreement between the two groups. Findings: While the un-weighted Kappa was calculated to be 0.172 (95% CI: 0.115- 0.228), the linear-weighted Kappa and the quadratic-weights Kappa were obtained as 0.312 (95% CI: 0.253- 0.370) and 0.482 (95% CI: 0.363- 0.601), respectively. Conclusions: Compared with data from the literature, the inter-rater reliability of ESI triage between the surveyed nurses and physicians was low to moderate. This finding emphasizes the need for retraining the triage staff on robust stratification of the patients in order to achieve a higher reliability in ESI triaging. Our results also provide motivation for further large-scale studies to estimate the average reliability of triage in Iranian EDs and if proven to be low, taking interventional measures.