From Triage to Treatment: an Exploration of Patient Flow Systems in Emergency Departments

Abstract

With overcrowding and increasing waiting times leading to angry and frustrated patients and clinical staff, Emergency Departments (EDs) need to ensure their patient flow processes – from triage to treatment – improve patient safety and satisfaction. Under conventional triage processes, all patients enter the ED through one portal, and treatment priorities are based on clinical assessments. This process disadvantages lower triage category patients, who have to endure unpredictable and often lengthy delays before receiving treatment. Extended waiting times can create an environment which leads to difficult behaviour and increased rates of patient initiated violence, as well as risk to patients who leave EDs without being medically assessed. There are also further risks posed by undifferentiated patients who may deteriorate while waiting for treatment.

To find an effective approach to managing or reducing waiting times for lower triage category patients processed through one particular metropolitan ED, an extensive search of the literature revealed several different patient flow processes, but not all suited local conditions. These approaches are discussed, in relation to suitability for the particular ED. The history of triage, including how and why it evolved, plus the realities of triage today are explored. Included are case examples of two patients on a journey through the department the way it is presently, and how it could be if particular approaches are introduced.

Extending nursing practice by introducing nurse-initiated x-rays at triage and the introduction of a separate stream for minor category patients in a dedicated ambulatory care area is one approach that could improve waiting times for these patients. There would be the added advantage of improving triage compliance figures for category three patients. The additional costs involved in such a process could be offset by improved efficiency in terms of waiting times, improved triage compliance figures, happier patients and clinical staff, and an emptier waiting room.