The Manchester Triage System in acute coronary syndromes

Abstract

Introduction: A growing number of hospitals have implemented the Manchester Triage System (MTS) in their Emergency Department (ED), so as to better prioritize the evaluation of those attending these departments.

Objectives: To assess whether the MTS was used effectively in patients admitted to the hospital with a diagnosis of acute coronary syndrome (ACS).

Methods: We evaluated 114 consecutive patients admitted to the Cardiology Department with a diagnosis of ACS. We recorded the color assigned in the MTS, mean time from arrival in the ED to MTS, mean time from MTS to first medical assessment (1-MA) and mean time from 1-MA to admission. We also analyzed the correlation between the type of ACS and clinical presentation and its relation with MTS.

Results: Of the 114 patients, one was coded red (0.9%), 71 orange (62.3%), 12 green (11%), and two were not assigned a color code according to MTS because they were admitted via a Medical Emergency and Resuscitation Vehicle. Mean time from arrival in the ED to MTS was 5.2 +/- 0.6 min and from MTS to MA was 20 +/- 2.5 min. In patients triaged as orange the time from MTS to MA was 15.1 +/- 1.5 min, as yellow 36.2 +/- 7 min, and as green 35.2 +/- 20.6 min (p = 0.003). Mean time from 1-MA to admission was 144.4 +/- 17 min, with no differences according to triage code or ACS type. Clinical presentation influenced triage and the speed of 1-MA and admission, patients with typical presentation being evaluated and admitted more quickly.

Conclusions: Most patients admitted for ACS are initially triaged as orange or yellow, an indication for prompt assessment in the ED; this has a positive effect on time to first medical assessment, but has no effect on time to hospital admission.