DIFFERENCES IN PRIORITIES ASSIGNED TO PATIENTS BY TRIAGE NURSES AND BY CONSULTANT PHYSICIANS IN ACCIDENT AND EMERGENCY DEPARTMENTS

Study Objectives-To investigate whether the greater urgency assigned t o accident and emergency patients by triage nurses than by accident an d emergency doctors was uniform across all patient groups. Design-Pati ents attending an accident and emergency department between 8.00 am an d 9.00 pm over a six week period were assessed prospectively for degre e of urgency by triage nures, and retrospectively for urgency by one o f two consultant accident and emergency doctors. Patients were grouped according to their clinical mode of presentation. Setting-An accident and emergency department of a district general hospital in the Midlan ds, UK, in 1990. Patients-1213 patients who presented over six weeks. Measurements and main results-As might be expected, patients' conditio ns were assessed as being more urgent prospectively than retrospective ly. This finding, however, was not uniform across all patient groups. Nurses' assessments of urgency tended to favour children and patients who presented with eye complaints and gave less priority to medical ca ses, particularly those with cardiorespiratory symptoms. Conclusions-T hese findings have implications for all those involved in the organisa tion of triage systems and in the training of nurses in accident and e mergency departments. It is essential that judgements on how urgently patients need to be seen are made in a completely objective manner.