Using modified triage system to improve emergency department efficacy: A successful Lean implementation

ABSTRACT

Introduction: Most emergency departments in rural hospitals practice single-tier triage system. We propose adding a secondary triage, a 2-tier triage system that can improve the department efficacy.

Methods: This was a single-centre pre–post-interventional study conducted in a district emergency department. During pre-interventional phase, patients were triaged by usual practice using single-tier system. For post-interventional phase, a secondary triage was added. A physician was also added to the secondary triage during peak hours. All patients who came during pre- and post-intervention phases were recruited for analysis. The primary outcomes were department length of stay (LOS) and left without being seen (LWBS) rate.

Results: There were 5007 patients (pre-intervention period) and 4970 patients (post-intervention period) recruited for data analysis. Intervention had reduced the overall LOS from 106 to 85 min (mean, p < 0.001). Subgroup analysis showed reduced LOS for non-critical cases from 72 to 45 min (mean, p < 0.001), but no significant improvement for critical and semi-critical cases. The LWBS rate was also reduced from 4.1% to 2.0% (p < 0.001).

Conclusions: Secondary triage system with an addition of physician during peak hours has been proven to improve emergency department LOS and LWBS rate.

KEYWORDS:

• Emergency overcrowding
• triage
• lean healthcare

Acknowledgement

The authors would like to thank the Director General of Health Malaysia for permission to publish this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

The study was approved by Medical Review & Ethics Committee (MREC), Ministry of Health Malaysia with waiver of informed consent.

Additional information

Notes on contributors

Leong Shian Peng

Leong Shian Peng is currently an emergency physician in Hospital Port Dickson. He is also an expert committee member of Health Technology Assessment for National Early Warning Scores in Malaysia.

Mohd Faizal Rasid

Mohd Faizal Rasid was a medical officer in Emergency Department Hospital Port Dickson. He is currently undergoing his master degree in Emergency Medicine.

Wan Immi Salim

Wan Immi Salim was a medical officer in Emergency Department Hospital Port Dickson. She contributed substantially for Lean projects in the department.