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Introduction
Triage is the process of sorting or prioritising patients for medical care on arrival at an emergency department (ED). Theoretically, the decision of the triage level is made to determine how long the patient will wait before seeing a physician and to treat patients in a timely and appropriate manner. 1 In general, hospitals all over the world use some kind of triage system such as 3-level, 4-level or 5-level scales to prioritise the patients in EDs. However, in Taiwan, a 4-level triage scale was developed and has been used as a reference for triage decisions in the EDs since 1999. 2 Furthermore, triage is predominantly performed by registered nurses in the EDs. 3 The 4-level triage scale, with each acuity level associated with the waiting time limits, is as follows: level 1 requires immediate medical attention; level 2 requires attention within 10-15 min; level 3 requires attention within 30 min; and level 4 means care is not very urgent and the patient can be seen at the outpatient department. There are 24 criteria for level 1 (life-threatening), 15 for level 2 (emergency) and 9 for level 3 (urgent). 4 Before patient acuity can be determined, a nurse needs to collect information such as the patient's chief complaints and some physical examination data such as vital signs, symptoms and signals. ED patients can then be assigned to appropriate triage categories and receive medical intervention promptly.
In spite of uncertain situations and enormous pressure to control costs in today's healthcare system, triage nurses are expected to perform professionally and correctly. Nevertheless, triage is a complex and dynamic process so triage judgements at levels that are too high or too low can occur as a result of the internal and external information presented. If a triage category is selected which is different from the one that a patient actually requires, the patient's waiting time until medical intervention may be affected more than anticipated. 5 It is therefore necessary to understand what factors may affect the accuracy of triage nurses' judgement in order to alter the factors in an effective way. However, few studies have been undertaken of the factors influencing triage nurses' acuity judgements in EDs. In addition, factors that might influence nurses' accuracy judgements, particularly...