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NTS is a reliable and valid standard for the triage of adults throughout the emergency care chain

Source: newsletter Radboudumc – April 2021

Research institute IQ healthcare (Radboudumc) from Nijmegen has been commissioned by the NTS Foundation to conduct a scientific study into the validity and reliability of the Dutch Triage Standard (NTS) in adults.

Nationwide survey
In a national study, 41 cases with real and common health complaints were assessed by 102 experienced triage nurses from the 3 partners in the emergency care chain: the GP Post (HAP), the Ambulance Control Room (MKA) and the Emergency Department (ED). The triage nurses used the NTS in their assessment of urgency. An expert panel determined in advance the most appropriate urgency of each case. This expert opinion formed the reference standard in the study. The investigators compared the urgency assessment of the NTS triage nurses with the reference standard. They also compared the urgency assessments between the triage nurses. A total of 4182 assessments took place.

Determination of urgency
The study showed a sensitivity of 95%:
Highly urgent cases were therefore also assessed as high urgent in 95% of the cases. The specificity was 83%. This means that 17% of the truly low-urgency cases were assessed as high-urgency. The sensitivity of the NTS is high, but the specificity seems to be improved. The reliability of the inter-raters for all triage nurses together and for each chain partner separately was good. Triage nurses perform triage with the NTS in a similar way, with almost all of them arriving at the same urgency. Finally, the results turned out to be very similar between the three chain partners.

Opportunities for more collaboration
This comprehensive study shows that the NTS is a reliable and valid standard for the triage of adults throughout the emergency care chain. The agreement in urgency assessment of the HAP, MKA and A&E triage nurses is promising and provides opportunities for increasing cooperation and personnel exchange in combined emergency rooms. Follow-up research in practice is needed to be able to make statements about the safety and effectiveness of triage of actual patients.

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