Electronic triage systems in emergency departments (EDs) typically allow nurses to adjust the triage ratings assigned by the computers. The implications for triage validity are yet unknown. Do nurse-generated triage scores correlate with admission, intensive care unit (ICU) consultation, and mortality rates better than computer-generated scores? Study of all adult patients admitted to a tertiary ED using a retrospective, observational cohort design. The Canadian Triage Acuity Scale (CTAS) score for each visit was created via an electronic application of the CTAS.
The triage nurse occasionally revised the computer-generated CTAS score to a level they deemed more appropriate. Researchers evaluated the rate of acuity-related outcomes (mortality, ICU consultation, and hospital admission) in each CTAS level as classified by nurse-generated versus computer-generated scores among visits with nurse-modified triage scores. Out of a total of 229,744 patients, 19,566 (8.51%) had their triage scores adjusted by nurses. Most of these changes were increasing the acuity triage score from what the computer had initially suggested. The acuity outcomes were the same or greater for visits with nurse-generated triage scores of 1-2 compared to visits with computer-generated CTAS scores of 1-2.
Conversely, visits with triage scores 4–5, according to the nurse-generated ratings, had a lower incidence of the outcomes than visits that were CTAS 4–5 according to the computer-generated CTAS scores. Nursing supervision of the computer-automated CTAS triage system was associated with fewer hospital admissions, ICU consults, and deaths in the triage score 4–5 categories, suggesting a safer triage approach than the automated CTAS algorithm alone.