Triage accuracy and consistency: The development and evaluation of the Triage Quality Assessment Software

Mr Wayne Varndell1,2, Mr Alister Hodge1, Mrs Kylie Lovato1, Miss Alison Jeffers1, Mrs Nadya Marquez-Hunt1

1Prince Of Wales Hospital, Randwick, Australia, 2University of Technology Sydney, Ultimo, Australia

Background: Triage is a critical component of emergency department (ED) practice, affecting patient access to care in relation to clinical urgency, disposition within the ED and subsequent allocation of staff and equipment resources. Triage decision-making accuracy has been reported to vary from as much 32.2% to 83.8%.1 Inaccurate or inconsistent triage decision-making translates into variable waiting times and disparate access to emergency care between patients with similar clinical urgency, which are associated with increased patient morbidity and moratlity.1-3  However, there is currently no standard approach to examining triage decision-making using the Australasian Triage Scale to inform quality improvement activites.1  Methods such as direct observation or videoing to assess triage decision-making are problematic.  The Triage Quality Assessment Software (TQAS) has been developed for use by EDs to retrospectively evaluate triage accuracy and consistency, and identify opportunities for improvement.

Aim: The aim of this study is to: i) examine the feasibility and reliability of the Triage Quality Assessment Software, ii) describe triage accuracy and consistency across four metropolitan EDs; and, iii) highlight areas of under and over triage.

Method: A random sample (n=100) of triage records from each site will be appraised by gold standard auditors using TQAS; feasibility will be assessed by questionnaire.

Results:  We will report the results of an initial trial of the TQAS derived from a series of measures testing its feasibility and reliability, and describe triage accuracy and consistence across four metropolitan EDs.

Conclusion:  Inaccuracy or inconsistency in triage decision-making can potentially result in increased patient morbidity and mortality, and negatively affect ED resources. The TQAS is the first of its kind that has been developed to assist in improving triage decision-making and supporting the development of emergency nurses who undertake the role of triage.


Wayne Varndell is Clinical Nurse Consultant at Prince of Wales Hospital Emergency Department, and College of Emergency Nursing Australasia NSW Branch President.  Wayne is an active clinician and researcher in emergency healthcare and nursing, and has received nearly $1M in competitive research and project funding.