Factors that affect the flow of patients through triage

Abstract

Objective: To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. Design: A two-phase study comprising observation of 16 h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870 min including 257 patients and for 16 different members of the triage staff. Results: No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13 min 34 s; the average length of time to triage for a patient was 4 min 17 s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively ''seen and treated'' in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. Conclusions: The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non-qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.

Mapping patient flow in a regional Australian emergency department: A model driven approach

“…The RAs commented on the high standard and professionalism of the clinical personnel carrying out the triage process, the clerical personnel carrying out the data entry and collection of patient medical records, and the communication between ambulance staff and ED staff. This professionalism and efficiency is consistent with the findings of Lyons et al (2007) study of factors that affect the flow of patients through triage.…”

“…Hospital management had expressed a need for empirical data relating to the patient flow and journey through the ED as there was a lack of evidence to support proposals for improvements in the ED. There are examples in the literature that utilised models and identified factors contributing to patient delays in the ED patient journey (Miro et al, 2003) or stages of the journey (Lyons et al, 2007;Storrow et al, 2008). However most studies focused on use of models to improve patient flow (Saunders and Dempsey, 2008;Jensen and Crane, 2008;Medeiros et al, 2008;Welch et al, 2007) rather than to document a detailed understanding for purposes of service planning.…”

Waiting Time for Assistance Using the Machester Triage System in an Emergency Hospital

“…18 Outros fatores que podem afetar o tempo de espera para a triagem são: tempo gasto pelo enfermeiro para conduzir pacientes para o local de tratamento, o que os leva a se ausentarem da sala de triagem e a classificação de pacientes que são encaminhados para o atendimento nos setores de especialidades médicas. 19 Estudo focando o tempo de espera e de interação com pacientes de um serviço de urgência de um país subdesenvolvido usando um sistema de triagem mostrou a necessidade de melhorar o tempo para a triagem e para o atendimento pelo médico, pois o tempo de espera dos pacientes não se adequava ao preconizado para o protocolo utilizado na instituição. 20 Embora não descrito no STM, por ser uma peculiaridade dos serviços brasileiros, o tempo 4 também foi alvo deste estudo.…”

What happens at triage: a naturalistic observational study

“…Previous UK research has identified similar issues with interruptions to the triage process 15. However, we are unaware of any previous observational studies of triage activities in EDs using the Manchester Triage System.…”