[Prognostic value of the reception, attendance and classification of patients in the emergency department of a tertiary hospital].
The objective of this investigation is to study the usefulness, validity and reproducibility of the reception, attendance and classification of emergency cases employed by nurses in the emergency department of a tertiary hospital (Hospital de Navarra, Pamplona, Spain) (RACHN). By studying the proportion of emergencies classified according to our triage system (reception, attendance and classification [recepción, acogida y clasificación] at the Hospital de Navarra, RACHN), we carried out a transversal descriptive study between 3rd November and 17th November 2003 to evaluate the concordance between the level of severity assigned by a nurse using the RACHN triage system and that determined by a senior doctor. In addition, we evaluated the discrepancy between the degree of severity assigned by a nurse using the triage system and the level of severity determined by a senior doctor and that between the request for complementary tests by the nurse with the opinion of a senior doctor. During the study period, 85.3% of the emergency cases were assigned severity levels using the 4 level scale RACHN triage system. The kappa index for severity assigned by the nurse was 0.76 (95%CI: 0.66-0.86) and that of the senior doctor, 0.71 (95% CI: 0.60-0.81). The discrepancy in severity was 26.1%. The request for complementary tests by the nurse proved correct in 95.2% of the cases, as determined by the senior doctor. The RACHN triage system depends primarily on the protocol established by the nurse that carries out triage. We have found a good degree of concordance between triage carried out by the nurse using the RACHN and that determined by the doctor. We believe the discrepancy can be reduced by establishing a five level scale of severity and by carrying out periodic reviews of the RACHN.