Enhancing Triage Accuracy: A Clinical Audit of the Manchester Triage System Implementation

NCT05944406 | Completed

• 1 other identifier: 887456
• Study Type: observational
• Target: 494
• Locations: 1 country
• Sites: 1

Brief Summary

This clinical audit focused on improving how patients are prioritized and managed in the emergency department. The audit took place in a hospital in Rawalpindi and involved two cycles of data collection. The results showed that after an educational intervention, there was an improvement in accurately triaging patients and a decrease in cases that were categorized as urgent when they were not. The audit also revealed a decrease in non-urgent cases visiting the emergency department. The findings highlight the importance of proper training, following triage guidelines, and referring non-urgent cases to other departments. The suggestions include improving the triage process and making the emergency department more efficient for better patient care.

Conditions

Triage

Outcome Measures

Primary Outcomes (2)

• The number of patients categorized into each triage category by the Triage Nurse

  The study aimed to assess how effectively the triage nurses in the Emergency Department (ED) of Benazir Bhutto Hospital, Rawalpindi, categorized patients into different triage categories based on their presenting symptoms. The triage decisions made by the triage nurses were compared with the triage decisions made by the emergency physicians, using the discharge diagnosis as a benchmark. The accuracy of triage was determined by evaluating whether the assigned triage category matched the severity of the patients' condition as indicated by the discharge diagnosis. The study focused on identifying cases of under-triage, over-triage, accurate triage, and un-triage to assess the overall effectiveness of the triage process and to identify areas for improvement.

  3 months

• The number of patients categorized into each triage category by the ER Physician

  The patients were categorized into triage categories by the ER Physician upon arrival to doctor (after triage from Triage counter, by the Triage Nurse). This triage was based on the discharge diagnosis and the ER Physician's evaluation.

  3 months

Secondary Outcomes (2)

• Number of patients who presented to the ER with cases that didn't require emergency management

  3 months

• Time between patient's arrival to ER and being attended to by the doctor (waiting time) for each triage category

  3 months

Study Arms (2)

Audit Cycle 1

These are the patients included in the first cycle of the clinical audit. The study collected data from a sample of 256 patients who visited the Medical Unit I of Benazir Bhutto Hospital, Rawalpindi, during the specified period. The patients were triaged by the triage nurses using the Manchester Triage System (MTS). Their age, gender, registration time, time of consultation, triage category assigned by the triage nurse, and admission decision were recorded for analysis. The accuracy of triage and waiting times were assessed for these patients.

Audit Cycle 2

These are the patients included in the second cycle of the clinical audit, conducted after an educational intervention for the triage nurses. The study collected data from a sample of 238 patients who visited the same Medical Unit I of Benazir Bhutto Hospital, Rawalpindi. Similar to audit cycle 1, these patients were triaged using the MTS, and their demographic information, triage category, and admission decision were recorded. The study aimed to evaluate any improvements in triage accuracy and waiting times compared to audit cycle 1 after the intervention and training of the triage nurses.

Other: Educational training of ER Nurses

Interventions

Educational training of ER Nurses OTHER

educational intervention was conducted from 2nd to 5th May 2023 with the triage nurses. This intervention comprised of detailed explanations of how the Triage system is accurately used to categorize the patients presenting in the ED and Triage nurses were instructed to refer non-urgent cases to either the Outpatient department or to the Casualty Medical Officer. The results of the first audit were also shared. Additionally, circulars containing instructions regarding accurate usage of MTS were distributed to all triage nurses

Audit Cycle 2

Eligibility Criteria

• Age: 13 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

The study population in this clinical audit consisted of patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi The study population encompassed patients of all age groups and genders who visited the ED during the specified audit cycles and met the inclusion criteria.

You may qualify if:

• Patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi.
• Patients whose data was recorded and available for analysis.
• Patients of all age groups and genders.
• Patients who visited the ED during the specified audit cycles.

You may not qualify if:

• Children (age\<13 years)
• Patients whose data was incomplete or missing crucial information for analysis.
• Patients who were not seen by a doctor and did not receive a discharge diagnosis.
• Patients who visited the ED outside the specified audit cycles.
• Patients who were transferred to another facility before receiving triage or medical assessment.

Sponsors & Collaborators

• Rawalpindi Medical College: lead

Study Sites (1)

Benazir Bhutto Hospital

Rawalpindi, Punjab Province, 46000, Pakistan

Location

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: June 27, 2023
• First Posted: July 13, 2023
• Study Start: March 20, 2023
• Primary Completion: June 10, 2023
• Study Completion: June 10, 2023
• Last Updated: July 13, 2023

Record last verified: 2023-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)