Table 1

Problems identified using the fishbone analysis

  • Staff not adequately trained in triage protocols

  • Poor coordination among triage staff. Lack of clarity on who can do what

  • Overcrowding of patients near ED entry points delaying patient movement and transfer

  • Understaffing in the triage room

  • Inappropriate OPD referrals which do not require emergency care

  • Poor maintenance of triage registers withoutmentioning the time of patient arrival

  • Triage is not considered an important function

  • Bed unavailability inside the ED caused a delay in transferring patients out of the triage room

  • Poor signage system for patients

  • Unnecessary materials occupying the triage room (use of the triage room as a storeroom)

  • Small entry gate to the triage room causing difficulty in trolley movement

  • Only analogue clocks in the emergency room make it difficult to record exact time

  • Poor quality of patient transport trolleys

  • Frequent malfunctions of patient monitors in the ED and delayed  repair of monitors

  • Double entry of patient data in the triage register and then ‘red patient register’

  • No colour bands to identify sicker patients

  • Communication delays between the triage room and ED

  • Poor digitisation of the ED

  • No departmental policy for triage process

  • Policy of frequent and random rotation of ED staff hindered triage skill development and team formation

  • ED, emergency department; OPD, outpatient department.