IMPROVED PEDIATRIC-PATIENT FLOW IN A GENERAL EMERGENCY DEPARTMENT BY ALTERING TRIAGE CRITERIA

Objective: To evaluate the effect of altering pediatric triage criteri a on ED triage scoring and patient flow. Methods: A prospective observ ational study of a pediatric triage modification was performed. Data f or all pediatric patients presenting to an urban general ED during a s ix-month study period were collected, After the first three months, pe diatric triage criteria were altered by elevating the acuity of severa l historical items and specifically listing abnormal signs and symptom s. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignme nts, and times to examination, disposition, and admission. Results: Al tering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients the re was a significant decrease (p < 0.05) in the mean times to ED exami nation (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a s ignificant impact on these results were a history of color change, dec reased activity, and prematurity with complications. Conclusions: A si gnificant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues.