Triage implementation audit at the adult emergency department of Debre Tabor Comprehensive Specialized Hospital in Ethiopia

Introduction

In an emergency room, triage is a crucial element that determines the clinical urgency of patients. Triage can dictate important decisions on the use of resources and the treatment that patients need. Many patients are seen later than necessary, wasting resources and time, and some may even be discharged without being seen, risking their lives. This study aimed to determine whether the triage tool was fully completed, properly measured, and documented, the triage early warning score (TEWS) was calculated, and whether patients were examined, distributed, and managed in appropriate areas.

Methods

An institution-based cross-sectional study with a retrospective chart review was conducted at Debre Tabor Comprehensive Specialized Hospital by selecting patients’ charts using simple random sampling among patients who visited the adult Emergency Department from January 1, 2021, to December 31, 2023. The descriptive statistics were presented to characterize individual variables, and cross-tabulation was used to see the relationship between individual patient-related factors and their final triage status.

Results

From the randomly selected 345 patients’ charts, 67 (19.4 %) didn't contain a triage sheet. The total triage early warning score was correctly calculated for only 21 (7.6 %) patients and properly triaged. Most of the patients were improperly triaged (92.4 %, n = 257), of which 253 (91 %) were under-triaged and four (1.4 %) were over-triaged. Fischer's exact test revealed a statistically significant relationship between patients’ color-coding category, triage early warning score documentation, and the use of clinical discriminators and final triage assessment (p = 0.007, p = 0.000, and p = 0.000 respectively).

Conclusion

The status of our triage implementation is alarming and specifically the level of under-triage. There is a significant gap regarding the application of clinical discriminators and TEWS calculations.