Pre-triage wait times for non-ambulance arrivals in the emergency department: A retrospective video audit

Abstract

Background: Pre-triage emergency department (ED) waiting times can be lengthy when presentation numbers are high. Queuing is random, affecting flow management and patient care. We investigated pre-triage wait times and barriers to triage access at an Australian ED.

Methods: A reviewer conducted a retrospective audit of triage reception security video camera footage (February-March, 2020). The reviewer manually documented self-presenting patients' wait-to-be-seen times and barriers to patient flow.

Results: The audit identified three main topics: lengthy pre-triage wait times, pre-triage queuing and observed barriers to triage. Median pre-triage wait time was 12 min (IQR = 5-21; n = 141), with no apparent relationship between patients' wait time and time of arrival. During peak or busy periods, multiple random queues formed at the triage reception area. Triage nurses could not concurrently triage and provide queue control during busy periods.

Conclusions: Unrecorded pre-triage wait times may exceed 20 min. This unseen time may extend beyond the estimated post-triage wait times suggested by the Australasian Triage Scale (ATS). There was a degree of disorder in patient queueing, reducing effective door-to-triage productivity. Larger studies could determine these findings' external replicability, with additional research addressing potential benefits of pre-triage queuing processes or a departmental concierge.

Keywords: Australasian Triage Scale (ATS); Emergency Medicine; Pre-triage; Time factors; Triage.