Interrater reliability of the Australasian Triage Scale for mental health patients.

OBJECTIVE: To evaluate interrater reliability of the Australasian Triage Scale (ATS) for mental health patients in ED. METHODS: In a prospective descriptive study, triage nurses were shown video vignettes of simulated scenarios of mental health presentations. Trieurs (raters) were asked to allocate an ATS category (rating) to each case. The primary outcome was the degree of interrater reliability for each simulated case. Also assessed were differences between raters or settings, grouped by level of ED activity, state of origin, hospital type and familiarity with appropriate guidelines. Chi-squared analysis was used for independent categorical variables; the Friedman test was used to compare the triage scores between busy and quiet ED scenarios. Ordinal data results were compared using opartchi. RESULTS: All 90 eligible participants were enrolled. The highest interrater concordance was 65.6% whereas the lowest interrater concordance was 53.3%. Significant association occurred between the distribution of triage ratings, ED activity level and the state of origin. A busy ED resulted in the assignment of a more urgent ATS category and decrease in concordance. CONCLUSIONS: There is a need to develop and implement a validated, standardized national triage tool for mental health patients. The ATS per se is insufficient to ensure acceptable interrater reliability, particularly during busy periods in the ED, and between states. Given the influence the ATS has on key outcomes, it is imperative for this tool to be robust.

Emergency department length of stay independently predicts excess inpatient length of stay.

OBJECTIVE: To examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS). DESIGN: Retrospective review of presentations and admissions data. SETTING: Three metropolitan hospitals in Melbourne, 1 July 2000 to 30 June 2001. MAIN OUTCOME MEASURES: Mean IPLOS for four categories of EDLOS (12 hours); excess IPLOS, defined as IPLOS exceeding state average length of stay; odds ratios for excess IPLOS adjusted for age, sex and time of presentation. RESULTS: 17 954 admissions were included. Mean IPLOS for the four categories of EDLOS were 12 hours, 7.20 days (P < 0.001). The corresponding excess IPLOS were 0.39, 1.30, 1.96 and 2.35 days (P < 0.001). Compared with EDLOS 4-8 hours, odds ratios (95% CIs) for excess IPLOS associated with the other three categories of EDLOS were 12 hours, 1.49 (1.36-1.63), after adjusting for elderly status, sex and time of ED presentation. CONCLUSION: EDLOS correlates strongly with IPLOS, and predicts whether IPLOS exceeds the state benchmark for the relevant diagnosis-related group, independently of elderly status, sex and time of presentation to ED. Strategies to reduce EDLOS (including countering access block) may significantly reduce healthcare expenditure and patient morbidity.