Pediatric nurse triage. Its efficacy, safety, and implications for care

F. P. Rivara, H. P. Wall, P. Worley and K. D. James

This study evaluates emergency room (ER) triage at a large urban children's hospital, in which patients are routinely referred outside of the institution for care. Seven hundred forty-eight children from 1 week to 17 years of age were enrolled in the study over a six-week period. Nearly two thirds (61%) of the patients were sent outside of the hospital for care; 31% of the patients were sent to community health centers, 17% were sent to private physicians' offices, 13% were sent home (self-care), and only 9% were treated in the ER. Ninety-four percent of appointments--of which 74% were kept--were for care within two days of the triage visit, with patients who were sent to the ER or hospital clinics keeping more appointments than those who were sent outside the hospital for care (97% vs 89% vs 62%). Patients who had an appointment on the same day kept it better than those who waited one to three days, who in turn had a higher rate of appointment-keeping than those who waited more than three days (81% vs 63.4% vs 41.2%). The physician's diagnosis agreed with the triage nurse's diagnosis or was less serious than the nurse's diagnosis in 93.4% of patients. At two weeks after triage, nearly all patients had completely recovered, with no correlation of symptoms with level or site of care. This study indicates that nurse triage of pediatric walk-in patients, in which three of five patients are referred outside of the hospital for care, is a safe and effective alternative to care in the ER and, at the same time, serves to reinforce community health centers as the appropriate setting for primary care.