The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland

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Abstract

Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.

Section snippets

Context

The emergency department at Cork University Hospital is a medium sized Emergency Department (ED) located on the outskirts of Cork city in southern Ireland with 55,000 new attendances each year. The department is one of three emergency departments within Cork city, which has a population of 123,000 (Census 2002). The department is the main emergency referral centre for the Southern Health Board region, which covers an area of approximately 4750 square miles and a population of 500,000 (Census

The International Picture

The literature reports that a systematic method of triage is in operation in many of the emergency departments of developed countries (Australasian College for Emergency Medicine 2000; Beveridge 1999; Cheung et al. 2002; Manchester Triage Group 1997). Triage has been defined by Gerdtz and Bucknall (2001) as a dynamic decision-making process that prioritises a persons need for medical care on arrival at an ED. It is usually performed by nursing staff trained in a recognised triage system.

Domestic picture

A number of high-level strategic documents provided the impetus to examine the process of triage in the ED. These will be briefly discussed.

A value for money audit commissioned by the Department of Health and Children identified a number of inherent weaknesses in the Irish health care system. Specifically the authors included ‘The lack of application of effective systems supported by the evidence, for example triage (Deloitte & Touche 2001).

The National Health Strategy (Department of Health and

Conclusion

The MTS has been successfully introduced in the emergency department. Decisions made at triage are now made using an evidence-based system. There is a transparent and logical route to the decision-making process. Documentation standards conform to the minimum data set of the MTS and include the presenting problem, the discriminator and the colour or category applied. The availability of a minimum data set will aid the audit process.

It is evident that many triage systems are in use in EDs within

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