Enhancing Triage Accuracy: A Clinical Audit of the Manchester Triage System Implementation

Triage Clinical Trial

Official title:

Enhancing Triage Accuracy and Streamlining Emergency Department Services: A Clinical Audit of the Manchester Triage System Implementation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05944406
• Other study ID #: 887456
• Status: Completed
• Start date: March 20, 2023
• Est. completion date: June 10, 2023

Study information

• Verified date: July 2023
• Source: Rawalpindi Medical College
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This clinical audit focused on improving how patients are prioritized and managed in the emergency department. The audit took place in a hospital in Rawalpindi and involved two cycles of data collection. The results showed that after an educational intervention, there was an improvement in accurately triaging patients and a decrease in cases that were categorized as urgent when they were not. The audit also revealed a decrease in non-urgent cases visiting the emergency department. The findings highlight the importance of proper training, following triage guidelines, and referring non-urgent cases to other departments. The suggestions include improving the triage process and making the emergency department more efficient for better patient care.

Description:

This clinical audit aimed to assess the accuracy and effectiveness of the Manchester Triage System (MTS) implementation in a hospital's emergency department. The audit took place in Medical Unit I of Benazir Bhutto Hospital, Rawalpindi, over two cycles from March to June 2023. The hospital, affiliated with Rawalpindi Medical University, is a 750-bed tertiary care facility located in a busy city. The emergency department, equipped with approximately 91 beds, follows triage guidelines established by the hospital. The triage process involves categorizing patients based on their presenting problem and determining the time within which they should be evaluated and treated by a doctor. To conduct the audit, certain standards were set before assessing the triage process. These included ensuring guidelines on patient categorization into triage categories, using a standard triage box in the patient record sheet, setting waiting time limits for each category, and using the discharge diagnosis of the doctor as a benchmark for triage accuracy. The audit involved two cycles: the first from March to April 2023 and the second from May to June 2023. Convenience sampling was used to select a sample size of 256 patients for the first cycle and 238 patients for the second cycle. Data collection involved recording patient demographics, registration and consultation times, triage categories assigned by the triage nurse, admission decisions, and independent assessment of triage accuracy by a pair of doctors. After completing the first cycle, an educational intervention was conducted with the triage nurses, providing detailed explanations on accurate usage of the MTS and instructing them to refer non-urgent cases to the outpatient department or the Casualty Medical Officer. Circulars containing instructions regarding MTS usage were also distributed. The second cycle was then conducted, following the same data collection procedure.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 494
• Est. completion date: June 10, 2023
• Est. primary completion date: June 10, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 13 Years and older

Eligibility

Inclusion Criteria:

• Patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi.
• Patients whose data was recorded and available for analysis.
• Patients of all age groups and genders.
• Patients who visited the ED during the specified audit cycles.

Exclusion Criteria:

• Children (age<13 years)
• Patients whose data was incomplete or missing crucial information for analysis.
• Patients who were not seen by a doctor and did not receive a discharge diagnosis.
• Patients who visited the ED outside the specified audit cycles.
• Patients who were transferred to another facility before receiving triage or medical assessment.

Related Conditions & MeSH terms

• Triage

Intervention

Other:
• Educational training of ER Nurses
educational intervention was conducted from 2nd to 5th May 2023 with the triage nurses. This intervention comprised of detailed explanations of how the Triage system is accurately used to categorize the patients presenting in the ED and Triage nurses were instructed to refer non-urgent cases to either the Outpatient department or to the Casualty Medical Officer. The results of the first audit were also shared. Additionally, circulars containing instructions regarding accurate usage of MTS were distributed to all triage nurses

Locations

Country	Name	City	State
Pakistan	Benazir Bhutto Hospital	Rawalpindi	Punjab

Sponsors (1)

Lead Sponsor	Collaborator
Rawalpindi Medical College

Country where clinical trial is conducted

Pakistan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The number of patients categorized into each triage category by the Triage Nurse	The study aimed to assess how effectively the triage nurses in the Emergency Department (ED) of Benazir Bhutto Hospital, Rawalpindi, categorized patients into different triage categories based on their presenting symptoms. The triage decisions made by the triage nurses were compared with the triage decisions made by the emergency physicians, using the discharge diagnosis as a benchmark. The accuracy of triage was determined by evaluating whether the assigned triage category matched the severity of the patients' condition as indicated by the discharge diagnosis. The study focused on identifying cases of under-triage, over-triage, accurate triage, and un-triage to assess the overall effectiveness of the triage process and to identify areas for improvement.	3 months
Primary	The number of patients categorized into each triage category by the ER Physician	The patients were categorized into triage categories by the ER Physician upon arrival to doctor (after triage from Triage counter, by the Triage Nurse). This triage was based on the discharge diagnosis and the ER Physician's evaluation.	3 months
Secondary	Number of patients who presented to the ER with cases that didn't require emergency management	A significant portion of the study focused on non-urgent cases that presented to the Emergency Department (ED). These non-urgent cases refer to patients whose medical conditions or symptoms did not require immediate or urgent medical attention. They were evaluated by two independent ER Physicians and labelled 'non-urgent' if they booth sufficiently believed this case required no emergency care and there was no jurgency to get checked by a doctor for the patient. Instead, these cases could have been appropriately managed in the outpatient setting, such as through scheduled appointments in clinics or primary care facilities	3 months
Secondary	Time between patient's arrival to ER and being attended to by the doctor (waiting time) for each triage category	The waiting time each patient spent before they were attended to by the doctor was measured and recorded according to the triage category they belonged to.	3 months