Emergency department crowding affects triage processes

Abstract

Introduction: During emergency department (ED) crowding there is an imbalance between the need for emergency care and available resources. We assessed the impact of crowding on the triage process.

Methods: A 1-year health records review of 49,539 patient visits was performed. Data extracted included: occupancy ratio, ED occupancy, demographics, length of stay (LOS), time to triage, triage score, years working as a triage nurse, and triage destination. Data were analyzed using descriptive statistics and regression analyses.

Results: During crowding, target times to triage elapsed more often than during non-crowding (49.7% vs. 24.9%, P <0.001), and more patients were not triaged (2.2% vs. 1.6%, P <0.001). A higher ED occupancy was associated with longer waiting times for triage and longer LOS (P <0.001). There were 12,627 (25.5%) patients redirected to the general practitioner cooperative (GPC). No association between level of crowdedness and number of patients who were redirected to the GPC was found (P = 0.122). Redirection to the GPC occurred significantly more often when the triage nurse had more years working as a triage nurse (P <0.001).

Conclusion: At this hospital, crowding affects the triage process, leading to longer waiting times to triage and longer ED LOS. Crowding did not influence triage destination.

Keywords: Emergency department crowding; Emergency service, hospital; Overcrowding; Triage.