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. 2025 Feb 4:16:1477844.
doi: 10.3389/fpsyg.2025.1477844. eCollection 2025.

A new Bayesian method for the estimation of emergency nurses' thresholds and agreement in the context of telephone triage

Michele Vicovaro  1 , Giuseppe Mignemi  1 , Massimo Nucci  1 , Luigi Bolognani  2 , Sara Iannattone  1 , Giovanni Bruno  1   3 , Andrea Spoto  1
Affiliations

A new Bayesian method for the estimation of emergency nurses' thresholds and agreement in the context of telephone triage

Michele Vicovaro et al. Front Psychol. .

Abstract

Introduction: Triage is the process aimed at ensuring that patients receive a level and quality of care matching the urgency of their conditions. The present study focuses on telephone triage. We discuss the application of a new decision-making model to the task of telephone triage.

Methods: The model allows to estimate the nurse's Belonging Threshold (BT), which quantifies the minimum level of severity of an emergency scenario that leads the nurse to activate a rescue vehicle with emergency devices. The BT can be used as an index of the possible tendency of the nurse to systematically over-or under-triage. The model also provides accurate estimations of the level of agreement between different nurses, and between the nurses and reference experts, net of the noise due to the possible differences between the nurses' BTs.

Results and discussion: The model and the related experimental procedure were applied to a sample of 21 emergency nurses at the SUEM 118 Operations Center in Venice. We discuss how the model can be useful to identify nurses who would benefit from a training to improve the consistency of their application of the protocol, as well as to identify specific emergency scenarios for which the assignment of priority codes was most problematic.

Keywords: Bayesian estimation; emergency; inter-rater agreement; nursing; telephone triage.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
BT of each nurse. Solid horizontal line: BT sample mean; dashed lines: indicative margins for thresholds that are either too high (i.e., >0.70) or low (i.e., <0.30).
Figure 2
Figure 2
Correlation between percentage of white or green codes assigned in 2019 and BT.
Figure 3
Figure 3
Cohen’s κ between each nurse and the reference experts. Solid horizontal line: mean Cohen’s κ between each nurse and the reference experts; dashed lines: indicative threshold of acceptable interrater agreement (i.e., 0.60).
Figure 4
Figure 4
Cohen’s κ between each nurse and all the other nurses. Solid horizontal line: mean Cohen’s κ between each nurse and the other nurses; dashed lines: indicative threshold of acceptable interrater agreement (i.e., 0.60).
Figure 5
Figure 5
Proportion, across all nurses, of instances where the nurses’ dichotomized decision, adjusted after applying the BM estimation and the std BT = 0.50, matched the reference experts’ dichotomized response, as a function of the reference experts’ ratings of urgency of the scenario. Note that the proportions of agreement for scenarios with the same average ratings were averaged.
See this image and copyright information in PMC

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