Do triage systems in healthcare improve patient flow? A systematic review of the literature

Australian Health Review

Volumn 35, Issue 3, 2011, Pages 371-383

  Harding, Katherine E ^a,b   Taylor, Nicholas F ^a,b   Leggat, Sandra G ^b  

^a EASTERN HEALTH   (Australia)

^b LA TROBE UNIVERSITY   (Australia)

Author keywords

delivery of healthcare; length of stay; waiting lists

Indexed keywords

EID: 80052209316     PISSN: 01565788     EISSN: 14498944     Source Type: Journal    
DOI: 10.1071/AH10927     Document Type: Review

References (84)

1. Walters EH, Dawson DJ. Whole-of-hospital response to admission access block: the need for a clinical revolution. Med J Aust 2009; 191: 561-3.
2. Iserson KV, Moskop JC. Triage in medicine, part i: concept, history and types. Ann Emerg Med 2007; 49: 275-81. doi:10.1016/j.annemergmed. 2006.05.019 (Pubitemid 46273865)
3. Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J. Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study. Ann Emerg Med 1995; 25: 215-23. doi:10.1016/S0196- 0644(95)70327-6
4. Irion G. Prioritization/triage in acute care physical therapy departments. Acute Care Persp 1997; 5: 1-3.
5. Broadbent M, Jarman H, Berk M. Emergency department mental health triage scales improve outcomes. J Eval Clin Pract 2004; 10: 57-62. doi:10.1111/j.1365- 2753.2003.00459.x (Pubitemid 38233117)
6. Pardey TGM. The clinical practice of emergency department triage: application of the Australasian Triage Scale-an extended literature review. Part 1: evolution of the ATS. Australas Emerg Nurs J 2006; 9: 155-62. doi:10.1016/j.aenj.2006.09.003 (Pubitemid 44792571)
7. Bunn F, Byrne G, Kendall S. Telephone consultation and triage: effects on healthcare use and patient satisfaction. Cochrane Database Syst Rev 2004; CD004180.
8. Bond K, Ospina M, Blitz S, Friesen C, Innes G, Yoon P, et al. Interventions to reduce overcrowding in Emergency Departments. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2006.
9. Cooke M, Fisher J, Dale J, McLeod E, Szczepura A, Walley P, et al. Reducing attendances and waits in Emergency Departments: a systematic review of present innovations. Warwick, UK: National Co-ordinating Centre for NHS Service Delivery and Organisation; 2005.
10. Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, et al. The Delphi List: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998; 51: 1235-41. doi:10.1016/S0895-4356(98)00131-0 (Pubitemid 29009523)
11. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003; 83: 713-21. (Pubitemid 37238882)
12. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 2009; 55: 129-33. doi:10.1016/S0004-9514(09)70043-1
13. Maher CG. A systematic review of workplace interventions to prevent low back pain. Aust J Physiother 2000; 46: 259-69. (Pubitemid 32000350)
14. Systematic reviews: CRDs guidance for undertaking reviews in health care. York, UK: University of York; 2008. Available at: http://www. york.ac.uk/inst/crd/pdf/Systematic-Reviews.pdf [verified 19 July 2011].
15. Effect size calculator. Durham, UK: Durham University, 2008. Available at:http://www.cemcentre.org/renderpage.asp?linkID=30325017 [verified 1 September 2009].
16. Higgins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. Chichester, UK: Wiley; 2006.
17. van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003; 28: 1290-9. doi:10.1097/01.BRS.0000065 484.95996.AF (Pubitemid 36734620)
18. Chan TC, Killeen JP, Kelly D, Guss DA. Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Ann Emerg Med 2005; 46: 491-7. doi:10.1016/j.annemergmed.2005.06.013 (Pubitemid 41676745)
19. Hicks B, Raisz H, Segal J, Doherty N. The triage experiment in coordinated care for the elderly. Am J Public Health 1981; 71: 991-1003. doi:10.2105/AJPH.71.9.991 (Pubitemid 11044437)
20. Levsky ME, Young SE, Masullo LN, Miller MA, Herold TJS. The effects of an accelerated triage and treatment protocol on left without being seen rates and wait times of urgent patients at a military emergency department. Mil Med 2008; 173: 999-1003.
21. Pigott HE, Trott L. Translating research into practice: the implementation of an in-home crisis intervention triage and treatment service in the private sector. Am J Med Qual 1993; 8: 138-44. doi:10.1177/088571 3X9300800306
22. Reveley S. The role of the triage nurse practitioner in general medical practice: an analysis of the role. J Adv Nurs 1998; 28: 584-91. doi:10.1046/j.1365-2648.1998.00685.x (Pubitemid 128454020)
23. Bond PA. A staffed ED assessment room: impact on wait times for nonurgent patients at a Saudi Arabian hospital. J Emerg Nurs 2001; 27: 394-5. doi:10.1067/men.2001.116248 (Pubitemid 33077551)
24. Baumann MR, Strout TD. Team triage: addressing challenges to emergency department flow. J Healthc Qual 2006; 28(4): W4-3-W4-9.
25. Black HR. A nurse screening intake system to improve clinic efficiency. J Ambul Care Manage 1979; 2: 13-22.
26. Garraway WM, Akhtar AJ, Smith DL, Smith ME. The triage of stroke rehabilitation. J Epidemiol Community Health 1981; 35: 39-44. doi:10.1136/jech.35.1.39 (Pubitemid 11098818)
27. Graves J, Fleischman MH, Goldstein GD, Graves J, Fleischman MH, Goldstein GD. Derm access: a new triage system to rapidly identify suspicious skin lesions. Dermatol Surg 2006; 32: 1486-90. doi:10.1111/j.1524-4725.2006.32357.x (Pubitemid 44934898)
28. Gruffydd-Jones K, Hollinghurst S, Ward S, Taylor G. Targeted routine asthma care in general practice using telephone triage. Br J Gen Pract 2005; 55: 918-23. (Pubitemid 41763120)
29. Janssen PA, Still DK, Klein MC, Singer J, Carty EA, Liston RM, et al. Early labor assessment and support at home versus telephone triage: a randomized controlled trial. Obstet Gynecol 2006; 108: 1463-9. doi:10.1097/01.AOG. 0000247644.64154.bb (Pubitemid 44901022)
30. Rogers BA, Kabir C, Bradley N. An audit of orthopaedic referrals via Multi-Professional Triage Teams. Ann R Coll Surg Engl 2008; 90: 671-4. doi:10.1308/003588408X318174
31. Dale J, Crouch R, Lloyd D. Primary care: nurse-led telephone triage and advice out-of-hours. Nurs Stand 1998; 12: 41-5.
32. Hanson C, Tennant MTS, Rudnisky CJ. Optometric referrals to retina specialists: evaluation and triage via teleophthalmology. Telemed J E Health 2008; 14: 441-5. doi:10.1089/tmj.2007.0068 (Pubitemid 351913547)
33. Hogenbirk JC, Pong RW, Lemieux SK. Impact of telephone triage on medical service use: implications for rural and remote areas. J Agric Saf Health 2005; 11: 229-37. (Pubitemid 40794841)
34. Huckson S. Implementation of the Victorian Emergency Department Mental Health Triage Tool. Australas Emerg Nurs J 2008; 11: 80-4. doi:10.1016/j.aenj. 2008.02.007
35. Martin JM, Ryan G, Duchesne G. Clinical prioritisation for curative radiotherapy: a local waiting list initiative. Clin Oncol (R Coll Radiol) 2004; 16: 299-306. doi:10.1016/j.clon.2003.12.008 (Pubitemid 38696972)
36. Morrison A, Hull A, Shephard B. Triage in emergency psychiatry. Psychiatr Bull 2000; 24: 261-4. doi:10.1192/pb.24.7.261 (Pubitemid 30433483)
37. Patterson V, Humphreys J, Chua R. Email triage of new neurological outpatient referrals from general practice. J Neurol Neurosurg Psychiatry 2004; 75: 617-20. doi:10.1136/jnnp.2003.024489 (Pubitemid 38406663)
38. Testi A, Tanfani E, Valente R, Ansaldo GL, Torre GC. Prioritizing surgical waiting lists. J Eval Clin Pract 2008; 14: 59-64. doi:10.1111/j.1365- 2753.2007.00794.x
39. George K, MacDonald G. A new model of triage in an aged persons mental health service. Australas Psychiatry 2005; 13: 60-3. (Pubitemid 40514987)
40. Fisher L, Whalen KC, Fisher L, Whalen KC. A look at a two-step triage system: 'how one high volume, level I trauma center decreased long triage waits'. J Emerg Nurs 2004; 30: 584-5. doi:10.1016/j.jen.2004. 09.015 (Pubitemid 39625275)
41. Inglis G, Baggaley M. Triage in mental health-a new model for acute in-patient psychiatry. Psychiatr Bull 2005; 29: 255-8. doi:10.1192/pb. 29.7.255 (Pubitemid 40975718)
42. Lowe D, Barber L. Implementing a priority and waiting list system in an acute hospital setting. Int J Ther Rehabil 2005; 12: 294-8.
43. O'Donnell D. What works. Automated ER triage process saves money, speeds patient care. Health Manag Technol 1999; 20: 44-5.
44. Pardee DA. Decreasing the wait for emergency department patients: an expanded triage nurse role. J Emerg Nurs 1992; 18: 311-5.
45. Shrimpling M, Shrimpling M. Redesigning triage to reduce waiting times. Emerg Nurse 2002; 10: 34-7.
46. Rayner WJ, Neal JJ, Neal JJD. Pre-assessment triage of orthodontic referrals at an East Yorkshire Hospital. Br Dent J 2008; 204: 493-5. doi:10.1038/sj.bdj.2008.348
47. Weingarten SR, Ermann B, Riedinger MS, Shah PK, Ellrodt AG. Selecting the best triage rule for patients hospitalized with chest pain. Am J Med 1989; 87: 494-500. doi:10.1016/S0002-9343(89)80603-5 (Pubitemid 19274750)
48. Eastaugh SR, Hatcher ME. Improving compliance among hypertensives: a triage criterion with cost-benefit implications. Med Care 1982; 20: 1001-17. doi:10.1097/00005650-198210000-00003 (Pubitemid 13206748)
49. Kinney WC. Web-based clinical decision support system for triage of vestibular patients. Otolaryngol Head Neck Surg 2003; 128: 48-53. doi:10.1067/mhn.2003.33 (Pubitemid 36246119)
50. Lee TJ, Baraff LJ, Guzy J, Johnson D, Woo H, Lee TJ, et al. Does telephone triage delay significant medical treatment? Advice nurse service vs on-call pediatricians. Arch Pediatr Adolesc Med 2003; 157: 635-41. doi:10.1001/archpedi.157.7.635 (Pubitemid 36818642)
51. McHugh GA, Campbell M, Silman AJ, Kay PR, Luker KA. Patients waiting for a hip or knee joint replacement: is there any prioritization for surgery? J Eval Clin Pract 2008; 14: 361-7. doi:10.1111/j.1365-2753.2007.00866.x (Pubitemid 351643247)
52. Saunders PPR, Sibley LM, Richards JSF, Holland SP, Chow DL, Courtright P. Outcome of corneal transplantation: can a prioritisation system predict outcome? Br J Ophthalmol 2002; 86: 57-61. doi:10.1136/bjo.86.1.57 (Pubitemid 34074886)
53. Seddon ME, French JK, Amos DJ, Ramanathan K, McLaughlin SC, White HD. Waiting times and prioritisation for coronary artery bypass surgery in New Zealand. Heart 1999; 81: 586-92. (Pubitemid 29260181)
54. Salk ED, Schriger DI, Hubbell KA, Schwartz BL. Effect of visual cues, vital signs, and protocols on triage: a prospective randomized crossover trial. Ann Emerg Med 1998; 32: 655-64. doi:10.1016/S0196-0644(98) 70063-0 (Pubitemid 28550869)
55. Gallagher M, Huddart T, Henderson B. Telephone triage of acute illness by a practice nurse in general practice: outcomes of care. Br J Gen Pract 1998; 48: 1141-5. (Pubitemid 28172064)
56. O'Connell JM, Johnson DA, Stallmeyer J, Cokingtin D. A satisfaction and return-on-investment study of a nurse triage service. Am J Manag Care 2001; 7: 159-69. (Pubitemid 32156535)
57. Richards DA, Godfrey L, Tawfik J, Ryan M, Meakins J, Button E, et al. NHS direct versus general practice based triage for same day appointments in primary care: cluster randomised controlled trial. BMJ 2004; 329: 774-7. doi:10.1136/bmj.38226.605995.55 (Pubitemid 39361871)
58. Richards DA, Meakins J, Tawfik J, Godfrey L, Dutton E, Richardson G, et al. Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs. BMJ 2002; 325: 1214-7. doi:10.1136/bmj.325.7374.1214 (Pubitemid 35398787)
59. Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 2006; 84: 314-9. doi:10.2471/BLT. 04.019505
60. Zocco J, Williams MJ, Longobucco DB, Bernstein B, Zocco J, Williams MJ, et al. A systems analysis of obstetric triage. J Perinat Neonatal Nurs 2007; 21: 315-22.
61. Holroyd BR, Bullard MJ, Latoszek K, Gordon D, Allen S, Tam S, et al. Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial. Acad Emerg Med 2007; 14: 702-8. doi:10.1111/j.1553-2712.2007.tb01864.x (Pubitemid 47071771)
62. Subash F, Dunn F, McNicholl B, Marlow J. Team triage improves emergency department efficiency. Emerg Med J 2004; 21: 542-4. doi:10.1136/emj.2002.003665 (Pubitemid 39232178)
63. Bruijns SR, Wallis LA, Burch VC. Effect of introduction of nurse triage on waiting times in a South African emergency department. Emerg Med J 2008; 25: 395-7. doi:10.1136/emj.2007.049411 (Pubitemid 351998326)
64. Cain P, Waldrop RD, Jones J. Improved pediatric patient flow in a general emergency department by altering triage criteria. Acad Emerg Med 1996; 3(1): 65-71. doi:10.1111/j.1553-2712.1996.tb03306.x (Pubitemid 26080668)
65. Choi YF, Wong TW, Lau CC. Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department. Emerg Med J 2006; 23: 262-5. doi:10.1136/emj.2005. 025254 (Pubitemid 44295313)
66. George S, Read S, Westlake L, Williams B, Fraser-Moodie A, Pritty P. Evaluation of nurse triage in a British accident and emergency department. BMJ 1992; 304: 876-8. doi:10.1136/bmj.304.6831.876
67. Higgins GL, Lambrew CT, Hunt E, Wallace KL, Fourre MW, Shyrock JR, Redfield DL. Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol. Am J Emerg Med 1993; 11: 576-82. doi:10.1016/0735-6757 (93)90004-U (Pubitemid 23340137)
68. Mallett J, Woolwich C. Triage in accident and emergency departments. J Adv Nurs 1990; 15: 1443-51. doi:10.1111/j.1365-2648. 1990.tb01787.x
69. Partovi SN, Nelson BK, Bryan ED, Walsh MJ. Faculty triage shortens emergency department length of stay. Acad Emerg Med 2001; 8: 990-5. doi:10.1111/j.1553-2712.2001.tb01099.x (Pubitemid 32954752)
70. Paulson DL. A comparison of wait times and patients leaving without being seen when licensed nurses versus unlicensed assistive personnel perform triage. J Emerg Nurs 2004; 30: 307-11. doi:10.1016/j.jen. 2004.04.022 (Pubitemid 39060670)
71. Redmond AD, Buxton N. Consultant triage of minor cases in an accident and emergency department. Arch Emerg Med 1993; 10: 328-30. (Pubitemid 24007998)
72. Richardson JR, Braitberg G, Yeoh MJ. Multidisciplinary assessment at triage: a new way forward. EMA-. Emerg Med Australas 2004; 16: 41-6. doi:10.1111/j.1742-6723.2004.00541.x (Pubitemid 38552478)
73. Ryan B. Effects of formal triage on A&E waiting times. Nurs Times 1995; 91: 14.
74. Smart D, Pollard C, Walpole B. Mental health triage in emergency medicine. Aust N Z J Psychiatry 1999; 33: 57-66. doi:10.1046/j.1440-1614.1999. 00515.x (Pubitemid 29121901)
75. Terris J, Leman P, O'Connor N, Wood R. Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage. Emerg Med J 2004; 21: 537-41. doi:10.1136/emj.2002.003913 (Pubitemid 39232177)
76. Travers JP, Lee FCY. Avoiding prolonged waiting time during busy periods in the emergency department: is there a role for the senior emergency physician in triage? Eur J Emerg Med 2006; 13: 342-8. (Pubitemid 44715271)
77. Casas MJ, Kenny DJ, Barett EJ, Brown L. Prioritization for elective dental treatment under general anesthesia. J Can Dent Assoc 2007; 73: 321.
78. Tideman RL, Pitts MK, Fairley CK. Effect of a change from an appointment service to a walk-in triage service at a sexual health centre. Int J STD AIDS 2003; 14: 793-5. doi:10.1258/095646203322556093 (Pubitemid 37533136)
79. Knight VC, McNulty A. Triage in a public outpatient sexual health clinic. Sex Health 2006; 3: 87-90. doi:10.1071/SH05046 (Pubitemid 43829304)
80. Lai KYC. The establishment of a triage system in a child and adolescent psychiatry clinic in Hong Kong. Child Adolesc Ment Health 2006; 11: 204-7. doi:10.1111/j.1475-3588.2006.00412.x (Pubitemid 44650497)
81. Woodhouse AE. Reducing waiting times: using an opt-in system and changing prioritisation criteria. Child Adolesc Ment Health 2006; 11: 94-7. doi:10.1111/j.1475-3588.2005.00372.x
82. Jones E, Lucy C, Wadland L. Triage: a waiting list initiative in a child mental health service. Psychiatr Bull 2000; 24: 57-9. (Pubitemid 30237317)
83. Parkin A, Frake C, Davison I. A triage clinic in a child and adolescent mental health service. Child Adolesc Ment Health 2003; 8: 177-83. doi:10.1111/1475-3588.00068
84. Lynch G, Hedderman E. Tackling a long waiting list in a child and adolescent mental health service. Ir J Psychol Med 2006; 23: 103-6. (Pubitemid 44656498)