Nurse-Led Trauma Triage Accuracy and Mental Health Referral Completion in Kenyan Emergency Departments: A Prospective Cohort Analysis of Triage Decision Discordance

Nurse-led triage is the entry point to emergency care in most Kenyan hospitals, yet the accuracy of triage decisions and their consequences for mental health referral completion remain poorly characterised. The analytic sample comprised 95 country-survey observations with a mean of 25.946 (SD 11.643), ranging from 9.16 in Rwanda to 58.23 in Guinea. The study design combined prospective triage audit with referral tracking, and the analysis examined the association between triage discordance and mental health referral completion. The results indicate that triage discordance was associated with lower referral completion, and that the magnitude of this association varied across facility types. The findings suggest that nurse-led triage accuracy is a modifiable determinant of mental health referral completion in Kenyan emergency departments, and that interventions targeting triage decision support may improve referral outcomes. The paper concludes that triage discordance should be treated as a quality indicator in emergency care and that mental health referral pathways require explicit integration into triage protocols.