Accuracy of pediatric triage at Siriraj Hospital, Bangkok, Thailand

Background: Siriraj Hospital is a busy 2,500-bed hospital located in Bangkok, Thailand. It has over 1.7 million outpatients, including 120,000 emergency room visits a year, 20,000 of which are pediatric patients. The Pediatric Triage (Pedtriage) system has been in used since the year 2001, but the factors that affect the performance of triage nurse have not been evaluated. Objective: To compare the performance non-pediatric nurses who are responsible for pediatric patients in the emergency room before and after pediatric triage training at Siriraj Hospital. Material and Method: Pediatric Triage Training was set up for emergency room and outpatient department nurses between June and October 2006. The training consisted of 5 hours of didactic sessions on the concepts of pediatric triage and 4-5 hour sessions where the nurses were allowed to triage actual pediatric patients under the supervision of a triage-training nurse. A pre-test and post-test examination was administered. The outcome of triage performance was categorized into under-triage if the patient had an urgent or emergent condition and was triaged as non-urgent, over-triage if a patient had a non-urgent condition and was triaged as urgent or emergent. Statistical description included percent, averages, and standard deviation where appropriate. A standard 4x4 contingency table was used to calculate the sensitivity and specificity. For comparison of performance, a post-hoc analysis was done where the nurses were divided into two groups, those with work experience of less than or equal to 5 years (group 1) and more than 5 years (group 2). An independent samples t-test was used to determine the difference in performance between the two groups. Results: Overall, performance on pre-test - post-test differed significantly before and after training. The nurses in Group 1 had higher pre-test scores (Group 1 mean = 62.35%, Group 2 mean = 52.41%, p-value = 0.001), were less likely to overtriage (Group 1 mean = 4.11%, Group 2 mean = 6.46%, p-value = 0.021) and had higher specificity of triage than Group 2 (Group 1 mean = 95.61, Group 2 = 92.39, p-value = 0.019). However, the nurses in Group 2 had more improvement in their post-test scores (percent of improvement from pre-test: Group 1 mean = 8.56%, Group 2 = 34.69%, p-value = 0.005). Conclusion: Work experience is an important consideration in the triage knowledge and performance of non-pediatric nurses during triage training.