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Ability of triage nurses to predict, at the time of triage, the eventual disposition of patients attending the emergency department (ED): a systematic literature review and meta-analysis
  1. Michael Anis Mihdi Afnan,
  2. Tejas Netke,
  3. Parminder Singh,
  4. Helena Worthington,
  5. Fatima Ali,
  6. Changavy Kajamuhan,
  7. Arjan Nagra
  1. Medicine, Imperial College London, London, UK
  1. Correspondence to Michael Anis Mihdi Afnan, Medicine, Imperial College London, London SW7 2AZ, UK; michaelafnan{at}


Introduction Exit block is the most significant cause of poor patient flow and crowding in the emergency department (ED). One proposed strategy to reduce exit block is early admission predictions by triage nurses to allow proactive bed management. We report a systematic review and meta-analysis of the accuracy of nurse prediction of admission at triage.

Methodology We searched MEDLINE, Cochrane, Embase, CINAHL and grey literature, up to and including February 2019. Our criteria were as follows: prospective studies analysing the accuracy of triage nurse intuition—after gathering standard triage information—for predicting disposition for adult ED patients. We analysed the results of this test—nurse prediction of disposition—in a diagnostic test analysis review style, assessing methodology with the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. We generated sensitivity, specificity and likelihood ratios (LRs). We used LRs and pretest probability of admission (baseline admission rate) to find positive and negative post-test probabilities.

Results We reviewed 10 articles. Of these, seven had meta-analysable data (12 282 participants). The studies varied in participant selection and admission rate, but the majority were of moderate quality and exclusion of each in sensitivity analyses made little difference. Sensitivity was 72% and specificity was 83%. Pretest probability of admission was 29%. Positive and negative post-test probabilities of admission were 63% and 12%, respectively.

Conclusion Triage nurse prediction of disposition is not accurate enough to expedite admission for ED patients on a one-to-one basis. Future research should explore the benefit, and best method, of predicting total demand.

  • emergency department
  • triage
  • crowding
  • nursing
  • emergency departments
  • planning

Statistics from


  • Handling editor Mary Dawood

  • Contributors MAMA conceived the idea, collected and analysed the data, and wrote most of the paper. He is guarantor. TN and PS contributed to the idea’s conception, collected the data and contributed to writing the paper. TN, PS, HW, FA, CK and AN contributed equally to the paper. HW, FA, CK and AN contributed to the idea’s conception, collected the data and critically revised the manuscript. All coauthors listed above approve submission of this paper to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

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

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