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Abstract
Aims, Objectives and Background In a busy paediatric emergency department triage decisions are critical to patient flow (see figure 1). In addition to sorting patients by acuity the initiation of early interventions at triage is pivotal. Effective use of triage has the potential to significantly reduce lengths of stay.1,2
Method and Design Adhering to PRISMA guidelines, we utilised the key words ‘children’, ‘triage’ and ‘length of stay’ to search the MEDLINE and COCHRANE databases for relevant studies. Inclusion and exclusion criteria allowed a focused interrogation of the literature over the last two decades. Bibliographies & specialist journals were also searched to prevent important omissions.
Results and Conclusion Nine studies (two randomised controlled trials, seven non randomised) were found. Interventions included; reallocated staff for triage, a paediatrician in triage and a series of triage nurse initiated treatments, investigations and protocols. Average reductions in emergency department length of stay ranged from four to forty four minutes per patient.
The common principle identified was early decision making. Statistical significance was demonstrated with few exceptions. Estimates of bias were low. The quality of evidence was high.
Limitations included; uneven benefit (e.g. whilst overall length of stay was reduced, some patients waited longer) and over treatment. Triage nurse initiated treatment stood out as as having the most impact with the least additional cost. There were no adverse incidents.
Triage based interventions are an important strategy in reducing the length of stay for children attending an emergency department. Doing so represents a proactive step in tackling the growing problem of overcrowding in the paediatric emergency department.
References
Haybarker B (2015). Reducing Emergency Department Length of Stay by System Change. Walden Dissertations and Doctoral Studies [Accessed 27/7/21]
RCEM Tackling Emergency Department Crowding December 2015 [Accessed 27/7/21], Available at https://rcem.ac.uk/wp-content/uploads/2021/10/ED_Crowding_Overview_and_Toolkit_Dec2015.pdf