Clinical Audit of Emergency Department Triage: The Impact of Interventional Strategies

Background and objectives: The Iranian Ministry of Health and Medical Education (MOHME) has obligated health settings to follow the reference guidelines developed by the Ministry in implementing of emergency department triage system. The present study aimed at auditing the compliance of emergency department triage system in Shahid Madani hospital, in terms of compliance with MOHME guideline, and to explore the impact of relevant interventions in enhancing this compliance.   Methods: A check list developed based on the Ministry’s guideline was used as the study instrument. Two areas including inputs and processes were surveyed. After auditing the initial state of the triage system, interventional strategies such as keeping the triage active in the afternoon and night shifts, allocation of welcoming patient carrier, and training the staff on the standards of triage system was implemented and the triage system was re-audited. Descriptive statistics and graphs were used to describe the results. T-test was used to compare the degree of compliance before and after intervention.   Findings: Before introducing the intervention, a compliance degree of 80, 62, and 88%, the standards of physical space, staffing, facilities and equipment and 80%, 14% and 67% to service process, logistic process, and management process was identified, respectively. After implementation of intervention, the degree of compliance was found to be 80, 87, 92% for the three former areas, and 90%, 14% and 100% for the three latter areas, respectively. The overall degree of compliance showed a significant increase from 75% to 82% after intervention (P = 0.028).   Conclusions: The adherence of emergency department triage system to the reference standards can be improved by implementing relevant interventional strategies. The gap between degree of compliance after intervention and the ideal situation, however, shows the need for more comprehensive identification of the shortcoming and devising appropriate strategies.