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Factors that influence the accuracy of triage nurses' judgement in emergency departments
  1. Shu-Shin Chen1,
  2. Jih-Chang Chen2,
  3. Chip-Jin Ng3,
  4. Ping-Ling Chen4,
  5. Pi-Hsia Lee5,
  6. Wen-Yin Chang6
  1. 1Nursing Department, Taoyuan Armed Forces General Hospital, Taipei, Taiwan
  2. 2Department of Emergency Medicine, Chang Gung University and Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
  3. 3Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
  4. 4Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
  5. 5Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
  6. 6Graduate Institute of Nursing, College of Nursing, Taipei Medical University and Cathay General Hospital, Taipei, Taiwan
  1. Correspondence to Professor Wen-Yin Chang, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing St, Taipei 110, Taiwan; leslie{at}


Objectives To gain an understanding of the accuracy of acuity assessment made by emergency department (ED) triage nurses, to compare the differences between the characteristics of triage nurses according to hospital variables and the accuracy of acuity ratings, and to explore the influence of nursing variables on the judgement of triages.

Methods A cross-sectional questionnaire survey was conducted at the EDs of hospitals in northern Taiwan. Ten adult emergency case scenarios and a demographic sheet with high validity were developed to survey 279 triage nurses. Data were collected from April to October 2006. All data were analysed using percentage, mean, SD, independent t test, one-way ANOVA and a stepwise logistic regression analysis.

Results The average score of rating accuracy was 5.62 points (out of a possible total of 10 points), which was considered low. Approximately 24.3% (n=68) of nurses' triage ratings were under-triaged and 19.7% (n=55) were over-triaged. Factors included years of ED experience, hours of triage education, level of hospital and triage mode of delivery. These factors were identified as significantly affecting the accuracy of nurses' judgement (p<0.05; adjusted R2=40.0%).

Conclusion The scores of accuracy ratings for triage nurses can be improved if factors contributing to inaccuracy can be altered. The findings of this study can be used to guide improvements.

  • Acuity assessment
  • clinical decision-making
  • emergency care
  • triage accuracy

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  • Funding We would like to acknowledge the financial support provided by the National Science Council in Taiwan (NSC 95-2314-B-038-046), for which we are extremely grateful.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.