• M Christien van der Linden, Barbara E A M Meester, and Naomi van der Linden.
• Clinical Epidemiologist, Emergency Department, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, The Netherlands. Electronic address: c.van.der.linden@mchaaglanden.nl.
• Int Emerg Nurs. 2016 Nov 1; 29: 27-31.

IntroductionDuring 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.MethodsA 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.ResultsDuring 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).ConclusionAt this hospital, crowding affects the triage process, leading to longer waiting times to triage and longer ED LOS. Crowding did not influence triage destination.Copyright © 2016 Elsevier Ltd. All rights reserved.

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