Validating the implementation of the triage system in an emergency department in a University Hospital

Abstract

Introduction: The implementation of triage systems seeks to aid patient organisation in order to assure smooth patient flow. Inconsistency in the application of the triage system at a local university hospital has been a recent concern for the administrative faculty. Therefore, our aim was to validate the implementation of the Canadian Triage and Acuity Scale (CTAS), currently applied by nurses, in a university hospital. Materials and Methods: Patient information was collected in the Emergency Department and translated from real case scenarios into paper-based scenarios. A total of 49 cases were distributed among 45 nurses to categorise. The nurses' categorisations were compared with a CTAS expert's categorisations. Results: Of the 2,205 cases (49 cases each given to the 45 nurses), 49% (1,059 cases) were correctly categorised and 51% (1,146 cases) were miscategorised. Overtriage and undertriage percentages were 55.93% and 44.07%, respectively. The highest level of agreement between nurses and the expert categorisation was in category 1; the lowest was in category 5. Conclusion: The nurses' overall results were below expectations. Statistically significant variables affecting correct categorisation included age, experience, education level and nationality of the nurses. Nurses above the age of 45 years with more years of experience, obtained top scores. Nurses with the highest level of education also scored significantly higher. Filipino nurses scored better than nurses of other nationalities. With the widespread utilisation of triage systems in the region, further studies that evaluate their implementation are needed.