Research| Volume 49, ISSUE 2, P294-304.e5, March 2023

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“I Was Here First, Why Did They Go Before Me”: Examining Patients'Perceptions of Priority in a Psychometric Study of Emergency Department Triage

Published:December 23, 2022DOI:



      Unrealistic patient expectations for wait times can lead to poor satisfaction. This study’s dual purpose was: (1) to address disparities between patients’ perceived priority level and the Emergency Severity Index (ESI) assigned by emergency room triage nurses; and (2) to evaluate validity and reliability of using the Patient Perception of Priority to be Seen Survey (PPPSS) to investigate patient expectations for emergency department urgency.


      A two-group pretest-posttest quasi-experimental approach compared patient urgency opinions to nurse urgency ratings with and without a scripted educational intervention. This tested how closely patient perceptions were related to triage nurse ratings.


      Reliability for the PPPSS was acceptable (reliability = 0.75). Patients who were rated lower urgency on the ESI by triage nurses tended to self-report higher urgency (rho = −0.44, P < .01). Attitudes were more consistent in the posttest patient group who were exposed to the scripted verbal description of emergency department procedures (χ2 (1, N = 352) = 8.09, P < .01). Patients who disagreed with emergency nurse scores tended to be younger on average (eg, < 40 years old; rho = 0.69, P < .01). Male identified patients tended to be rated both by nurses and themselves as higher urgency (beta = 0.18, P = .02).


      We recommend the PPPSS for nurses and researchers to quickly assess patient expectations. Additionally, promoting patient understanding through a scripted educational strategy about the ESI system may also result in improvements in communication between patients and nurses.

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      Joshua Ray Tanzer is a Biostatistician, Lifespan Biostatistics, Epidemiology, Research Design, Informatics Core, Providence, RI.


      Marlene Dufault is Professor and Nursing Consultant, University of Rhode Island, Department of Nursing, Kingston, RI.


      Linda Roderick Rioux is Staff Nurse Newport Hospital Emergency Department, Department of Emergency Medicine, Newport, RI.


      Jason Machan is Director of the Lifespan ClinTECH Center and Lifespan Biostatistics, Epidemiology, and Research Design Core, Providence, RI.


      Kathy Bergeron is Clinical Nurse Educator, Newport Hospital and Adjunct Faculty, Department of Nursing, Salve Regina University, Newport, RI.


      Anthony Napoli is Professor of Emergency Medicine, Department of Emergency Medicine, Warren Alpert School of Medicine at Brown University and Chair, Department of Emergency Medicine, Newport Hospital Emergency Department, Newport, RI.