Agreement between triage category and patient's perception of priority in emergency departments

Toloo, Ghasem-Sam, Aitken, Peter, Crilly, Julia, and FitzGerald, Gerry (2016) Agreement between triage category and patient's perception of priority in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24. 126. pp. 1-8.

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Background: Patients attending hospital emergency departments (ED) commonly cite the urgency and severity of their condition as the main reason for choosing the ED. However, the patients' perception of urgency and severity may be different to the nurses' perception of their urgency and severity, which is underpinned by their professional experience, knowledge, training and skills. This discordance may be a cause of patient dissatisfaction. The purpose of this study is to understand the extent of agreement/disagreement between the patient's perceived priority and actual triage category and associated factors.

Methods: A cross-sectional survey of 417 patients attending eight public hospital EDs in Queensland, Australia between March and May 2011 was conducted. The survey included patient's perceived priority and other health-related, socio-demographic and perceptual factors. Patients' triage category data were retrieved from their ED records and linked back to their survey data. Descriptive and multinomial logistic regression analyses were used.

Results: Over 48 % of the respondents expected to be given higher priority than the actual triage category they were assigned; 31 % had their perceived priority matched with the triage category; and 20 % of the respondents expected a lower priority than the triage category they received (Kappa 0.07, p < 0.01). Patients who expected a higher priority tended to be more frequent users (≥3 times in the past six months), and to score higher on perceived seriousness, perceived urgency, and pain score compared to the patients whose perceived priority matched the triage category or anticipated a lower priority. In the multivariate analysis, only perceived urgency remained significantly associated with expected higher priority (OR = 1.27, 95 % CI: 1.14-1.43).

Discussion: Our findings clearly confirmed the discrepancy between patient perception of urgency and staff assessment of urgency. This can have important implications particularly for the patients who underrate the urgency of their condition. Improved and open communication and the incorporation of the 'patient voice' into the triage process require understanding the patient's perspectives and their involvement in the decision making process.

Conclusions: Noted differences between patient and practitioner perception of clinical urgency were identifed in this study.

Item ID: 49231
Item Type: Article (Research - C1)
ISSN: 1757-7241
Keywords: emergency department; iInter-rater agreement; patient perception; perceived priority; triage
Additional Information:

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Funders: Australian Research Council (ARC), Queensland Ambulance Service
Projects and Grants: ARC Linkage grant LP0882650
Date Deposited: 08 Jun 2017 05:24
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 100%
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