Improved emergency department efficiency with a three-tier trauma triage system

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Healthcare Systems Analysis

Background:

• Traditional two-tier trauma triage systems may have limitations in optimizing emergency department (ED) efficiency.
• In-hospital trauma care requires effective triage to ensure timely and appropriate patient management.
• Minimizing inappropriate triage is crucial for resource allocation and patient outcomes.

Purpose of the Study:

• To evaluate the impact of transitioning from a two-tier to a three-tier trauma triage system on ED efficiency.
• To determine if a three-tier system reduces overall ED time for trauma patients.
• To assess the effect of a three-tier system on the accuracy of trauma triage, specifically over-triage and under-triage.

Main Methods:

• A pilot study comparing a two-tier and a three-tier trauma triage system at an urban Level 1 trauma center.
• Patient data (n=197 for two-tier, n=240 for three-tier) were collected over six months, analyzing demographics, injury severity, ED times, and outcomes.
• Statistical analysis, including ANOVA, was used to compare outcomes between the two triage systems (p < 0.05 significance).

Main Results:

• Total ED time decreased significantly with the three-tier system (3.53 ± 2.14 h) compared to the two-tier system (3.98 ± 2.81 h, p = 0.001).
• Specific patient categories in the three-tier system (Category II and consults) showed reduced ED times compared to two-tier consults.
• The three-tier system resulted in minimal under-triage (5%) and over-triage (7.5%) with no significant change in complication rates.

Conclusions:

• Implementing a three-tier trauma triage system enhances the early involvement of trauma services.
• The three-tier system demonstrably decreases overall emergency department time for trauma patients.
• This refined triage approach effectively minimizes inappropriate patient categorization, improving trauma care efficiency.