Evaluating the Canadian Triage and Acuity Scale as a Predictor of Emergency Nursing Workloads in an Emergency Department Ambulatory Care Setting.

Abstract

Introduction: Emergency departments face unpredictable workloads owing to diverse patient presentations, often leading to crowding and increased waiting times. Current staffing models in Canadian emergency departments lack evidence-based methods to predict emergency nursing needs, potentially affecting patient safety and outcomes. Other triage systems, such as the Emergency Severity Index and Manchester Triage System, have been shown to have some predictive impact on emergency nursing workload. This study explores the relationship between patient acuity, as determined by the Canadian Emergency Department Triage and Acuity Scale, and emergency nursing workload in an ambulatory care area of an emergency department.

Methods: A prospective observational time-motion study was conducted in the ambulatory care area of a tertiary care academic emergency department. Research assistants used a custom application to observe emergency nurses and track patient presentations and the time emergency nurses spent on predefined tasks related to patient care.

Results: Data from 40 shifts, encompassing 557 patient encounters and 719 patient-care tasks, were analyzed. Emergency nurses spent approximately 80% of their shift on patient-care activities and 20% on breaks. Regression analysis showed no significant correlation between the Canadian Emergency Department Triage and Acuity Scale and time spent on "Orders - Investigations" tasks. However, there was a mild yet significant correlation between the Canadian Emergency Department Triage and Acuity Scale and "Orders - Treatments" tasks (r = 0.17; P = .003) and care coordination (r = 0.21; P = .005), indicating that higher-acuity patients required more emergency nursing time for treatments and care coordination.

Discussion: The Canadian Emergency Department Triage and Acuity Scale triage level is a weak predictor of emergency nursing workload in an emergency department ambulatory care setting. Further research is required to fully understand the relationship between the Canadian Emergency Department Triage and Acuity Scale and emergency nursing workload in emergency department ambulatory and nonambulatory settings.