Effect of introduction of nurse triage on waiting times in a South African emergency department

Abstract

Background: In a resource poor setting with poverty, a high burden of disease and critically low medical staff numbers, triage could potentially improve the long waiting times experienced at South African public hospital emergency departments (ED) and render timely emergency care to those in most need.

Aim: To evaluate the impact of introducing nurse triage (using the Cape Triage Score (CTS)) on waiting times for patients presenting to a South African public hospital ED.

Methods: Pre-triage waiting times were collected retrospectively through accessing hospital records of four randomly chosen months of the preceding year. This was compared with data collected prospectively over a 3 month period using nurse triage and the CTS triage tool. Captured data included CTS priority category, time of nurse triage and time of attendance by ED doctor.

Results: Waiting times were significantly reduced in all but the lowest priority category. The introduction of nurse triage, using the CTS, resulted in an overall reduction in waiting time from 237 min to 146 min (p<0.001). Patients triaged "red" (highest priority) demonstrated a mean reduction in waiting time from 216 min to 38 min (p<0.001).

Conclusions: The results demonstrate that use of the CTS, as implemented by trained nurses, dramatically reduced the waiting time of patients attending a busy public hospital ED in South Africa.