Radiograph ordering: agreement between the triage nurse and the physician in a pediatric emergency department.

We hypothesized that the triage nurse in a busy pediatric emergency department (ED) could accurately order radiographs, ultimately reducing patient waiting time. Protocols utilized to reduce patient waiting time are of importance in busy emergency departments. All patients registering at the ED of the Children's Hospital in a one-week period were entered into the study. The triage nurse documented whether they would send the patient for a radiograph, if allowed to, and were asked to designate a specific radiograph. The radiographs that were actually ordered by the physicians were subsequently obtained from radiology records. Data were analyzed for agreement beyond chance (kappa), positive (PPV) and negative predictive values. The results showed excellent agreement for extremity radiographs and poor agreement for nonextremity radiographs.