• Remco W Rosmulder, J J Koos Krabbendam, A H M Toon Kerkhoff, Erik R Schinkel, Ludo F M Beenen, and Jan S K Luitse.
• Universiteit Twente, afd. Operations, Organisation and Human Resources, Enschede, The Netherlands. r.w.rosmulder@amc.nl
• Ned Tijdschr Geneeskd. 2010 Jan 1;154:A1109.

ObjectiveTo investigate whether 'advanced triage' improved patient flow among self-referred patients in the emergency department of a level 1 trauma centre and, most importantly, whether the quality of medical care was maintained. In advanced triage, the triage nurse initiates additional diagnostic investigations independently.DesignInterventional study.MethodsAfter a baseline measurement had been carried out for eleven days (n = 506), the advanced triage protocol was tested during ten day or evening shifts (n = 198). The length of stay in the emergency department was measured. The attending emergency physician assessed the correctness and completeness of the additional diagnostics initiated by the triage nurse. Two traumatologists and two radiologists assessed the quality of x-ray imaging requests independently of each other.ResultsAverage patient length of stay (LOS) was reduced by fourteen minutes (14%). The improvement was achieved primarily in patients who required additional diagnostic investigations. Their average LOS decreased by 27 minutes (18%). There was an 8% increase in the total number of diagnostic investigations requested. The triage nurse initiated the investigations correctly and fully in 93% of cases. The quality of x-ray imaging requests remained the same as before the introduction of advanced triage.ConclusionThe implementation of advanced triage improved patient flow for self-referred patients in the emergency department without affecting the quality of medical care. Advanced triage was successful in the Dutch system, too.

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