Beyond Nurse Efficiency: A Multilevel Analysis of Nurse, Contextual, and Patient-Related Factors in Triage Duration.

Introduction: This study aimed to investigate the factors influencing triage duration in emergency departments, comparing the impact of individual nurse characteristics with contextual and patient-related variables.

Methods: This monocentric retrospective observational design, conducted from January 1, 2016, to December 31, 2022, analyzed 382,027 triage events at Merano Hospital. Data from periods affected by the coronavirus disease 2019 pandemic were excluded to ensure analysis under standard emergency conditions. Triage durations were evaluated using statistical models, including random effects, to capture both individual and systemic influences.

Results: A total of 51 nurses performed triage, with a median time of 1.9 minutes (interquartile range, 1.1-3.7). Nurse-related factors accounted for only 11.5% of the variability, whereas patient and contextual factors had greater influence. Older patients had longer triage times (+0.0079 min/y; P<.001). Arrival by ambulance increased triage time by 0.287 minutes compared with independent arrivals (P<.001). Higher priority levels were linked to shorter triage times, with priority 1 patients assessed 0.604 minutes faster (P<.001). Night admissions reduced triage times by 2.137 minutes (P<.001), whereas increased emergency department workload prolonged them (+0.692 minutes per additional patient; P<.001).

Discussion: Triage models should incorporate a broader range of contextual and patient-related factors rather than focusing predominantly on nurse efficiency. Further research is needed to comprehensively identify the determinants of triage performance, with the goal of optimizing both speed and quality in emergency care.