Triage effectiveness: a framework for quantifying the effect of emergency triage prioritization

Area of Science:

• Emergency medicine
• Healthcare systems analysis
• Clinical operations research

Background:

• Emergency departments (EDs) utilize triage to prioritize time-critical patients and minimize wait times.
• Existing methods lack a direct measure for the core clinical function of triage effectiveness.
• This study introduces Triage Effectiveness (TE) as a novel framework to quantify triage system performance.

Purpose of the Study:

• To develop and validate a quantitative framework, Triage Effectiveness (TE), for measuring the effectiveness of emergency department triage systems.
• To assess how well triage systems reduce waiting times for critically ill patients.
• To provide a method for evaluating both initial triage accuracy and the impact of post-triage reprioritization.

Main Methods:

• Developed TE as a scale (0-100%) using data from 463,209 ED visits across eight hospitals.
• Introduced two complementary measures: Waiting Time-based TE (WTE) and Rank-based TE (RTE).
• Validated TE calculations using analytical queueing models, assessing theoretical vs. observed performance and transferability.

Main Results:

• Queueing theory validation confirmed strong alignment between WTE and RTE calculations.
• RTE demonstrated greater robustness and less sensitivity to emergency department utilization.
• Substantial discrepancies between theoretical and observed TE were found, highlighting significant post-triage reprioritization.

Conclusions:

• The TE framework offers the first direct method to measure triage effectiveness, incorporating full ordinal priority information.
• TE can be used to assess initial triage efficiency and the influence of subsequent reprioritization within EDs.
• This framework enables objective evaluation of triage system performance and identifies areas for operational improvement.