Item selection and content validation of the nurse triage quality audit tool (N-TriQAT) in emergency departments: A consensus study

BACKGROUND: Nurse-led triage is a critical process for prioritizing patients in emergency departments. Inaccurate triage decisions may compromise patient safety and system efficiency. Despite use of systems such as the Canadian Triage and Acuity Scale (CTAS), few validated instruments exist to assess nurse-led triage quality, highlighting the need for tools such as the Nurse Triage Quality Audit Tool (N-TriQAT). OBJECTIVES: To select items and establish the content validity of the N-TriQAT. METHODS: A structured consensus study based on the RAND/UCLA Appropriateness Method was conducted, combining two Delphi rounds (electronic) and one virtual face-to-face round. A panel of 32 experts (emergency nurses, physicians, managers, CTAS instructors, and patient partners) was consulted. Experts evaluated and prioritized N-TriQAT items based on relevance and clarity using a nine-point Likert scale and a dichotomous clarity assessment. Median scores and I-CVI were used to determine consensus. RESULTS: Overall, 73 of 85 items were retained and organized into 11 domains aligned with the triage process. For retained items, I-CVI ranged from 0.45 to 0.97 with median scores from 6 to 9. Rejected items showed lower agreement (I-CVI 0.13-0.73; median 1.7-7). Strong consensus was observed for standardized components (acuity and clinical assessment), including documentation and time-based indicators. Empathy and communication items were less frequently retained, reflecting challenges in operationalization. CONCLUSION: This study provides a content-validated instrument (N-TriQAT) to assess nurse-led triage quality. Further psychometric evaluation and digital integration may facilitate its implementation in practice, supporting safer and higher-quality emergency care.