IMPROVED EMERGENCY DEPARTMENT EFFICIENCY WITH A 3-TIER TRAUMA TRIAGE SYSTEM

This pilot study was carried out to determine whether converting from a two-tier to a three-tier in-hospital trauma triage system improves t he efficiency of emergency department (ED) care and minimizes inapprop riate triage. Patients at an urban, Level 1 trauma centre were triaged using either a two-tier (months 1-3; n = 197) or three-tier (months 4 -6; n = 240) trauma response system. Patients were assessed for triage type, age, sex, injury severity score, Glasgow coma score, post-ED di sposition, total ED time, survival, complication rate, probability of survival and unexpected death. Comparisons were made by ANOVA table an alysis; significance was assumed for p<0.05. Two-tier (n = 197) and th ree-tier patients (n = 240) were matched with respect to mean age, sex , mean injury severity score, mean Glasgow coma score, post-ED disposi tion, survival and probability of survival. Two-tier patients were tri aged to give 20% alerts [criteria = physiological derangement (PD) and /or injury mechanism (MOI)] and 80% consults; three-tier patients were triaged as 20% category I (criteria = PD), 18% category II (criteria = MOI) and 62% consults. Total ED time decreased from two-tier categor y I times (2.09+/-1.64 vs. 1.95+/-1.75 h; p = 0.72). Category II patie nts (3.28+/-1.98 h; p = 0.009) spent less time in the ED than did two- tier consults (4.36+/-2.65 h). The mean ED three-tier consult time sig nificantly decreased as well (3.95+/-2.42 h, p = 0.008 vs. two-tier co nsult). Complications per patient were unchanged from two-tier to thre e-tier triage (0.17+/-0.52 vs. 0.12+/-0.48; p = 0.15). Under-triage (5 %) and over-triage (7.5%) were minimal under three-tier triage. It is concluded that using a three-tier triage system results in an increase in the early involvement of the trauma service while decreasing emerg ency department time and minimizing over-triage. (C) 1997 Elsevier Sci ence Ltd.