Emergency medicine triage practices across Canadian hospitals: a national survey

Triage in emergency departments (EDs) prioritizes patient care when demand exceeds resources. In Canada, the Canadian Triage and Acuity Scale (CTAS) is the nationally endorsed system used to guide triage decisions. Despite longstanding advocacy for standardized practices, implementation and training requirements vary across hospitals, and electronic decision-support tools have been increasingly integrated to support triage. This study aimed to describe current triage practices, staffing, and training across Canadian EDs.

We conducted a national, bilingual cross-sectional survey of ED staff across 10 provinces and three territories. A 21-item electronic questionnaire, developed by a multidisciplinary team, captured data on triage roles, training, tools, and protocols. Surveys were distributed via provincial and local ED leads, with follow-up reminders to maximize participation. Responses were summarized using descriptive statistics and reported as counts and percentages. The survey was conducted in accordance with the Kelley checklist.

A total of 1169 surveys were completed, mostly in English, from ten provinces and two territories with Ontario and Alberta being overrepresented. Respondents were predominantly registered nurses (79.1%) responsible for triage (99.1%), with most having more than 2 years of triage experience in addition to prior nursing experience (86.1%). The majority reported using the 2016 CTAS guidelines (54.8%) and electronic CTAS (53.9%). Most sites had minimum training requirements for triage staff (74.7%), with 91.4% of respondents having completed the NENA/CAEP CTAS participant course. Considerable variability existed in guideline awareness, training requirements, and triage practices.

Triage in Canadian EDs is predominantly performed by registered nurses with more than two years of triage experience, most of whom have completed formal CTAS training. Despite widespread guideline use and decision-support tools, practices remain inconsistent, underscoring the need for standardized training and implementation strategies to ensure safe, effective, and reliable triage across the country.