• Medicina · Apr 2023

    Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding-The CREONTE (Crowding and RE-Organization National TriagE) Study Group.

    • Gabriele Savioli, Iride Francesca Ceresa, Maria Antonietta Bressan, PicciniGaia BavestrelloGB0000-0002-5618-7404Faculty of Medicine, University of Pavia, 27100 Pavia, Italy., Angelica Varesi, Viola Novelli, Alba Muzzi, Sara Cutti, Giovanni Ricevuti, Ciro Esposito, Antonio Voza, Antonio Desai, Yaroslava Longhitano, Angela Saviano, Andrea Piccioni, Fabio Piccolella, Abdel Bellou, Christian Zanza, and Enrico Oddone.
    • Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy.
    • Medicina (Kaunas). 2023 Apr 17; 59 (4).

    AbstractBackground and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.

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