Verification of the reliability and validity of the Japanese Triage and Acuity Scale for emergency outpatients according to the working style of nurses

Abstract

Purpose: The Japanese Triage and Acuity Scale (JTAS) was developed based on the Canadian Triage and Acuity Scale (CTAS) and has been implemented in emergency departments in Japan. We verified the reliability and validity of JTAS according to the working style of nurses.

Methods: Ten emergency cases were prepared for 16 emergency and general outpatient nurses working in an emergency outpatient department, and the results were judged for each urgency level and triage process item. Obtained data were analyzed statistically.

Results: Inter-rater reliability was kappa = 0.79 between all nurses, kappa = 0.72 between emergency outpatient nurses, and kappa = 0.81 between general outpatient nurses. Based on the judgment of certified dedicated and general outpatient nurses, the correct answer rate was 66.6% and 63.6%, the under-triage rate was 12.0% and 20.9%, and the over-triage rate was 22.0% and 15.5%, respectively. The correct answer rate for each item in the triage process was higher for emergency outpatient nurses than for general outpatient nurses, with a significant difference in 17 out of 24 items.

Conclusion: JTAS was reliable but poorly relevant. General outpatient nurses may have the same valuation of acuity even if the process is incorrect, suggesting the need for proper education.