A nurse who inspected Aishwarya Aswath at a Perth hospital maintains her triage score was appropriate but says time constraints prevented a more thorough assessment.
Seven-year-old Aishwarya died of sepsis in April last year, hours after presenting to the Perth Children's Hospital emergency department with a fever and unusually cold hands.
She had been left in a waiting room for more than 90 minutes, despite her parents pleading with staff to escalate care as her condition deteriorated.
An inquest into her death is examining why their concerns were not acted upon earlier.
Aishwarya had been unwell for around 36 hours when she was brought to the hospital around 5.30pm on Easter Saturday by her father Aswath Chavittupara and mother Prasitha Sasidharan.
She was given a triage score of four - the second-least serious category - by nurse Jacqueline Taylor.
Ms Taylor on Thursday told the inquest she had been running the triage desk alone with 96 patients presenting during the afternoon shift.
CCTV footage showed Aishwarya being carried by her father to the desk and observed by Ms Taylor entirely through a screen during the three-minute triage process.
Ms Taylor said hands-on assessments were preferable but not possible due to time constraints.
Aishwarya was recorded as having diarrhoea, vomiting and a headache and feeling weak but Ms Taylor said she didn't know the girl had a fever.
She deemed Aishwarya, whose temperature was later recorded at 38.8C, to be alert and awake and likely suffering from gastro.
Counsel assisting Sarah Tyler said an expert witness, Sathiaseelan Nair, had deemed Ms Taylor's recording of Aishwarya's history and symptoms to be incomplete.
Dr Nair believed Aishwarya should have been given a triage score of three, rather than four.
Ms Taylor maintained the score was appropriate given the available information, saying it was not unusual for parents to seem anxious.
She did not believe there were any cultural barriers but acknowledged Aishwarya's care could have been escalated earlier had she undergone a more thorough triage assessment.
Ms Taylor, who is on parental leave from Perth Children's Hospital, said staff had been exhausted and demoralised at times.
She said while the hospital had since hired more nurses, some were still working double shifts.
Additional triage support had been provided but vital signs were generally not checked during the process.
"The whole department was under pressure, time pressure and exhaustion," she said.
"I don't believe they're up to an ideal standard yet."
Aishwarya was described as floppy and barely able to lift her head by the time she was finally moved from the waiting room to an assessment bay and then the resuscitation area.
She went into cardiac arrest and was pronounced dead around 9pm, having succumbed to an infection related to group A streptococcus.
Aishwarya's parents have said hospital staff were rude and dismissive and showed little urgency to address their concerns.
Another nurse who had examined Aishwarya recorded family concern as "zero", deputy state coroner Sarah Linton was told.
The inquest continues.
