Reducing door-to-triage time with improving triage coverage in a rural primary healthcare centre in India: a quality improvement project.

Abstract

Background: Early recognition, timely management and referrals of emergency and time-sensitive conditions are challenging in the fragmented emergency system of India in primary healthcare settings. Early triage helps in reducing time to care and appropriate referral to the facility for further care. The aim of our quality improvement (QI) project was (a) to reduce the door-to-triage time by 50% from the baseline over a period of 1 month and (b) to improve the coverage of triage from the baseline to 90%.

Methods: This study was conducted at the primary health centre (PHC) in the rural Northwestern region of India. The study was conducted from February 2023 to May 2023. The study was divided into three phases: pre-intervention phase (42 patients), intervention phase (204 patients) and post-intervention phase (42 patients). The team identified delays in patient registration and door-to-triage time as bottlenecks using process maps and fishbone analysis. Change ideas were tested through plan-do-check-act (PDCA) cycles using point-of-care QI methodology. Four cycles of PDCA were done in 1 month, which has led to improvements. The majority of change ideas focused on interventions like standardisation of triage protocol, re-organisation of resources and designating dedicated space for triage, training the healthcare providers on using various teaching methods and dedicated staff for triage.

Results: The changes have demonstrated a reduction in door-to-triage time from the baseline of 10 min to 3 min, with an improvement in triage coverage from the baseline to 100%.

Conclusion: A significant reduction in the door-to-triage time was observed with improvement in triage coverage by introducing standardised triage, optimally using the available resources, using case-based scenarios and simulation for training the staff and assigning a staff member dedicated to the triage process.