Setting and materials

Inclusion criteria for the study was hospital affiliated ED in Sweden (N = 68) [17]. Exclusion criteria was EDs with less than two co-located somatic specialties. Furthermore, the hospitals are classified into three categories regarding competencies; county, regional and university hospital. The county hospital has on average 12 to 13 medical areas of activity, the regional 23 and the university hospital 40. The university hospitals performs highly specialized medical care with a national intake [18]. In Sweden, the majority of the RNs hold a bachelors’ degree in nursing, and a specialist RN often hold a one-year master degree. Specific formal education in ED triage, is limited to those undergoing the Emergency Nursing Specialist Program.

A questionnaire (Additional file 1) was produced for the survey. Since the questionnaires from the two previous Swedish surveys [11, 13] were found insufficient related to the number of questions [13] and outdated formulations [11], a new questionnaire was produced. However, the new questionnaire originates from previous questionnaires as well as the results from those studies [11, 13]. The questionnaire was pilot tested twice for face validity by a total of five persons, four head of departments and one party responsible for triage at that particular ED. These respondents answered the survey’s 30 items, and 12 questions about the construction of the survey. The first pilot test performed by two respondents yielded some corrections. The second pilot, performed by the remaining three respondents, did not result in any further changes. However, the idea of making the survey electronic was suggested by one of these respondents. The electronic survey instrument esMaker was therefore applied to the survey. The 30 items on the final survey contained mostly close-ended questions in combination with the possibility to add information.