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Triaging the triage: reducing waiting time to triage in the emergency department at a tertiary care hospital in New Delhi, India
  1. Akshay Kumar1,
  2. Dheeneshbabu Lakshminarayanan1,
  3. Nitesh Joshi1,
  4. Sonali Vaid2,
  5. Sanjeev Bhoi1,
  6. Ashok Deorari2
  1. 1 Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Akshay Kumar, Emergency Medicine, All India Institute of Medical Sciences Ansari Nagar, New Delhi 110016, India; akshay2111{at}


Background Prolonged wait times prior to triage outside the emergency department (ED) were a major problem at our institution, compromising patient safety. Patients often waited for hours outside the ED in hot weather leading to exhaustion and clinical deterioration. The aim was to decrease the median waiting time to triage from 50 min outside ED for patients to <30 min over a 4-month period.

Methods A quality improvement (QI) team was formed. Data on waiting time to triage were collected between 12 pm and 1 pm. Data were collected by hospital attendants and recorded manually. T1 was noted as a time of arrival outside the ED, and T2 was noted as the time of first medical contact. The QI team used plan–do–study–act cycles to test solutions. Change ideas to address these gaps were tested during May and June 2018. Change ideas were focused on improving the knowledge and skills of staff posted in triage and reducing turnover of triage staff. Data were analysed using run chart rules.

Results Within 6 weeks, the waiting time to triage reduced to <30 min (median, 12 min; IQR, 11 min) and this improvement was sustained for the next 8 weeks despite an increase in patient load.

Conclusion The authors demonstrated that people new to QI could use improvement methods to address a specific problem. It was the commitment of the frontline staff, with the active support of senior leadership in the department that helped this effort succeed.

  • quality improvement
  • emergency department management
  • triage
  • performance improvement
  • change ideas

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  • Contributors AK: mentor and leadership in project, wrote first draft, edited and corresponded. DL: led data analysis and data collection. NJ: data collection and implementation of change ideas on the ground; organised training sessions for staff, facilitated negotiation with nursing staff. SV: data analysis and editing of manuscript, inputs for quality improvement methodology for this QI project. SB: conceptualised the whole project, taught and motivated triage staff, edited and reviewed the manuscript. AD: reviewed and edited the manuscript, gave inputs to improve methodology of the quality improvement project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.