Twelve key quality indicator categories were identified from CTAS guidelines.

Chief complaint and CTAS modifier were the most consistently reported.

Arrival mode and infection screening were the least reported quality indicators.

Nursing skill domains identified were: knowledge, clinical skills, professional attitudes.

Findings support future selection and validation of triage quality indicators.

Identify quality indicators for nursing triage outlined in the Canadian Triage and Acuity Scale (CTAS) guidelines and describe the skills and professional attributes required for nurses to perform high-quality triage.

Embase, PubMed, CINAHL, Cochrane Library, Web of Science, and 37 professional association websites.

This systematic review included CTAS guidelines published between January 1990 and August 2025. Guideline quality was appraised using the AGREE II tool. Quality indicators and nursing skills were standardized, grouped into conceptual categories, and their frequency was documented.

Nine guidelines were included, all of which were low quality. Twelve key quality indicator categories were identified. Of these, 100% of guidelines required that triage report chief complaints, objective clinical assessment, use of CTAS modifiers, and triage acuity levels. Documentation of the mode of arrival to the emergency department (22%) and infection risk screening and control measures (11%) were the quality indicators least reported on. Nursing skills were grouped into three core areas. The first was knowledge, encompassing clinical proficiency in physical and mental health as well as familiarity with ethical and legal concepts. The second comprised clinical skills, namely advanced judgment, therapeutic communication and accurate record keeping. The third focused on behavioral and professional attitudes, emphasizing empathy, confidence and autonomy.

These findings underscore the need to reinforce triage quality through education, audit tools, and monitoring. Given the low quality of existing guidelines, future consensus efforts are needed to validate and refine indicators, providing a foundation for improving triage quality.

Canadian Triage and Acuity Scale (CTAS)

Competency

Emergency Department (ED)

Nurse

Triage

© 2026 The Author(s). Published by Elsevier Ltd.