Patient experience of the triage encounter in a Swedish emergency department

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Abstract

Emergency department triage is a prerequisite for the rapid identification of critically ill patients and for allocation of the correct acuity level which is pivotal for medical safety. The patient’s first encounter with a medical professional in the emergency department is often with the triage nurse.

Objectives

To identify patient experience of the triage encounter.

Methods

A questionnaire focusing on the patient–triage nurse relationship in terms of satisfaction with the medical and administrative information, privacy and confidentiality in the triage area as well as triage nurse competence and attitude was answered by 146 participating patients.

Results

The majority of patients perceived that while they were triaged immediately upon arrival to the emergency department, they were often given limited information about the waiting time. Although almost a quarter of the patients did not wish to have information about their medical condition from the triage nurse, 97% of the patients considered the triage nurse to be medically competent for the triage task.

Conclusions

Patients were generally satisfied with the reception and care given by the triage nurses, but less satisfied about information about expected waiting time. We suggest therefore, that patients should be routinely informed about their estimated waiting time to be seen by the doctor in addition to their triage level.

Introduction

Emergency department (ED) triage is widely used in the western world (Fernandes et al., 2005). During the last decades, research on ED triage has focused more on the development of triage scales (Australasian College for Emergency Medicine, 2000a, Gilboy et al., 2003, Manchester Triage Group, 2006, Bullard et al., 2008) and less on patient perspective of the triage process (Topacoglu et al., 2004).

Section snippets

Background

Since the development of the Australasian Triage Scale in the 1990s (Australasian College for Emergency Medicine, 2000b), three other major scales have been introduced worldwide (Gilboy et al., 2003, Manchester Triage Group, 2006, Bullard et al., 2008). Only the Manchester Triage System (Manchester Triage Group, 2006) has evolved based on the needs of an European emergency unit.

In addition to these scales, local triage scales have been developed in several European countries. Within the

Design

This was a descriptive and observational cross-sectional single site study.

Participants and setting

The Karolinska University Hospital in Solna is a level one trauma centre. The ED treats approximately 70,000 adult patients presenting with non-psychiatric complaints annually. A two-tier triage system is used that includes spot check and comprehensive triage. The triage decisions are based on a five level triage scale called Adaptive Process Triage (ADAPT) developed at the Sahlgrenska University Hospital in Gothenburg,

Demographic information

A total of 695 patients presented at the ED during the data collection period, of which 601 (87%) fulfilled the inclusion criteria. Of the eligible patients, 165 (28%) were invited to participate in the study, 146 (88%) agreed to participate, of which 83 (59.5%) patients were women. Age ranged from 19 to 97, with a median age of 49.5 years. The majority, 117 (83%) were native Swedish speakers and just over half, 78 (53.1%) were accompanied by someone.

Time issues in the ED

In total, 58.7% of the patients perceived

Discussion

This study aimed to investigate patient experience of ED triage. As many as 76% of the patients either underwent triage shortly after their arrival in the ED (n = 84) or found the time to triage acceptable (n = 25). Since any kind of queue for triage is a potential threat to the safety of the patients, time to triage ought to be kept to a minimum.

Even though it is known that information about time to first doctor assessment is important for patient satisfaction (Björvell and Stieg, 1991, Bruce et

Conclusions

This study presents new information about patient satisfaction with ED triage from a Swedish perspective. Patients were generally satisfied with the reception and care given by the triage nurses. However, one important factor needs to be addressed in the ED, namely the fact that information about the expected waiting time was only communicated to a restricted amount of the patients. One suggestion is to routinely inform patients about their triage level, and their estimated waiting time before

Role of funding sources

There are no financial conflicts of interest in the current study. KG is a member of the national work group of ADAPT. Financial support for this study was given by the Department of Emergency Medicine, Karolinska University Hospital Solna.

Acknowledgements

We would like to thank Ankie Eriksson, Elin Magnusson and Tamara Barlow, all at the Department of Emergency Medicine at Karolinska University Hospital Solna for collecting data, providing electronic patient record data and language revision respectively. Further, we wish to thank the Department of Emergency Medicine at Karolinska University Hospital Solna for providing financial support for this study.

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