Testing the reliability and accuracy of urgency ratings determined by triage nurses for mental health scenarios, using the Canadian Triage and Acuity Scale

Abstract

Over-crowded emergency departments (EDs) are commonplace necessitating triage systems. Although several triage scales exist, the Canadian Triage and Acuity Scale (CTAS) is used across EDs nationally. Interestingly, few mental health scenarios have been included in studies testing the reliability and accuracy of the CTAS. Moreover, EDs are increasingly used by individuals in a mental health crisis. The purpose of this study was to test the inter-rater reliability and accuracy of triage nurses’ assignment of urgency ratings for mental health patient scenarios utilizing current CTAS guidelines. The overall Fleiss kappa for this sample of triage nurses (n=18) was 0.31180 representing only fair agreement while the Kendall’s coefficient was 0.67964 or moderate agreement. Both calculations were statistically significant (p<.0001). Several limitations exist nevertheless, observations from this study specifically, focus on the use of second order modifiers in education of triage nurses, may improve the inter-rater agreement for mental health presentations.