Zhila Yousefi
1 
, Kavous Shahsavarinia
2 , Mohammad Reza Narimani
3 , Hossein Feizollahzadeh
4* 1 Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Emergency Medicine, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Iranian Center of Excellence in Health Management (ICEHM), Taleghani Educational and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. Effective triage is a viable solution to improve performance indicators in the emergency department. This study aimed to compare the effect of conventional triage and team triage methods on the performance indicators of emergency department.
Methods. In this descriptive cross-sectional research, all 749 patients referred to the emergency department of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. A researcher-made checklist was used to collect emergency performance indicators. The data were extracted from patient records and recorded in the checklist. Data analysis was performed using descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software.
Results. Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible exit was lower compared to the conventional method (P < 0.05). In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels (P < 0.05).
Conclusion. According to our results, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. Therefore, it is recommended to consider this method in hospital emergency departments to provide better services and increase patient satisfaction.
Extended Abstract
Background
Due to the increasing number of patients being referred to the emergency department (ED), triage to prioritize patients has recently been proposed as a viable solution to address this issue. Effective triage is a viable solution to improve performance indicators in the ED. This leads to a more accurate identification of patients in need of urgent care and allows faster access to diagnostic and therapeutic measures. However, the traditional model of one-nurse triage alone is insufficient to assess patients and prioritize and meet their needs. The team triage method, as an innovative approach, can facilitate this process. The aim of this study was to compare the effect of conventional triage and team triage methods on ED performance indicators.
Methods
This descriptive cross-sectional research was approved by the Ethics Committee of Tabriz University of Medical Sciences, Tabriz, Iran (code IR.TBZMED.REC.1398.491). All 749 patients referred to the ED of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. In the first method, a trained nurse was stationed in the triage unit and assessed the referred patients based on the five-level emergency severity index triage system. In team triage, the triage team, consisting of a trained nurse and a doctor, was in the triage unit. The inclusion criteria were alertness, stable vital signs, grad 3 and above based on the Emergency Severity Index triage system, and age over 16 years. The exclusion criterion was non-compliance with more than 10% of the information. A researcher-made checklist was used to collect ED performance indicators. Indicators analyzed included the percentage of patients with determined status within six hours, the percentage of patients temporarily hospitalized, the percentage of discharges at their own responsibility, and the average length of triage at levels three, four, and five. The data were extracted and analyzed using the descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software.
Results
Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. Regarding educational level, most patients had a degree below high school diploma, and they had been transferred to the ED in personal vehicles. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible discharge was lower compared to the conventional method (P < 0.05). In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels (P < 0.05). Finally, the results showed that in the team triage group the percentage of patients with determined status within six hours was higher than in the conventional triage group; however, this difference was not statistically significant.
Conclusion
According to the results of this study, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. These indicators include the percentage of patients temporarily hospitalized, the percentage of discharges at their own responsibility, and the average length of triage at levels three, four, and five. It appears that the presence of a physician on the triage team facilitates and speeds up the process of diagnosing, treating, and timely discharge of patients referred to the ED. Therefore, it is recommended to consider team triage method in hospital EDs to provide better services and increase patient satisfaction.