A descriptive study of registered nurses' application of the triage scale RETTS©; a Swedish reliability study

Abstract

Background: From a patient safety perspective, it is of great importance that decision support systems such as triage scales are evidence based. In the most recent national survey, the majority of Swedish Emergency Departments (EDs) apply the Swedish triage scale known as the Medical Emergency Triage Treatment Scale (METTS), subsequently renamed the Rapid Emergency Triage Treatment Scale (RETTS©). Despite national widespread implementation, there has been limited research on METTS/RETTS©.

Aim: To determine the reliability of application by registered nurses of the RETTS© triage scale in two Swedish emergency departments.

Methods: In this prospective, cross-sectional study at two EDs, 46 written patient scenarios were triaged by 28 registered nurses (RNs). Data were analysed with descriptive statistics and Fleiss kappa (κ).

Results: The RNs allocated 1281 final triage levels. There was concordance in seven (15%) of the scenarios, and dispersion over two or more triage levels in 39 (85%). Dispersion across the stable/unstable patient boundary was found in 21 (46%) scenarios. Fleiss κ was 0.562, i.e. moderate agreement.

Conclusion: The inability of the triage scale to distinguish between stable/unstable patients can lead to serious consequences from a patient safety perspective. No general pattern regarding concordance or dispersion was found.

Keywords: Emergency service, hospital; Nurses, nursing staff hospital; Patient safety; Patient scenarios; Reliability – reproducibility of results; Triage – emergency service, hospital.