Anne Creaton, MB BS Senior Registrar in Emergency Medicine; Don Liew, MB BS, FACEM, Acting Director; Jonathan Knott, MB BS, FACEM, Head of Education and Research, Emergency Medicine; Melissa Wright, RN, Clinical Nurse Specialist.
Interrater reliability of the Australasian Triage Scale for mental health patients
Version of Record online: 1 JAN 2009
© 2008 The Authors. Journal compilation © 2008 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 20, Issue 6, pages 468–474, December 2008
How to Cite
Creaton, A., Liew, D., Knott, J. and Wright, M. (2008), Interrater reliability of the Australasian Triage Scale for mental health patients. Emergency Medicine Australasia, 20: 468–474. doi: 10.1111/j.1742-6723.2008.01131.x
- Issue online: 1 JAN 2009
- Version of Record online: 1 JAN 2009
- Accepted 6 August 2008
- Australasian Triage Scale;
- interrater reliability;
- mental health;
Objective: To evaluate interrater reliability of the Australasian Triage Scale (ATS) for mental health patients in ED.
Methods: In a prospective descriptive study, triage nurses were shown video vignettes of simulated scenarios of mental health presentations. Trieurs (raters) were asked to allocate an ATS category (rating) to each case. The primary outcome was the degree of interrater reliability for each simulated case. Also assessed were differences between raters or settings, grouped by level of ED activity, state of origin, hospital type and familiarity with appropriate guidelines. Chi-squared analysis was used for independent categorical variables; the Friedman test was used to compare the triage scores between busy and quiet ED scenarios. Ordinal data results were compared using opartchi.
Results: All 90 eligible participants were enrolled. The highest interrater concordance was 65.6% whereas the lowest interrater concordance was 53.3%. Significant association occurred between the distribution of triage ratings, ED activity level and the state of origin. A busy ED resulted in the assignment of a more urgent ATS category and decrease in concordance.
Conclusions: There is a need to develop and implement a validated, standardized national triage tool for mental health patients. The ATS per se is insufficient to ensure acceptable interrater reliability, particularly during busy periods in the ED, and between states. Given the influence the ATS has on key outcomes, it is imperative for this tool to be robust.