Does triage categorization influence time to initial electrocardiogram?

Abstract

Study objectives: We determine whether triage level is associated with differences in time to initial ECG. Methods: We prospectively enrolled a convenience sample of low-risk chest pain patients to our emergency department (ED) observation unit. Low risk was defined as having atypical clinical symptomatology with no significant ECG changes and troponin level less than 0.1 ng/mL. Triage acuity levels were recorded by the triage nurse using the Emergency Severity Index (ESI) 5-level triage system (1=highest acuity, 5=lowest acuity). Generally, patients with chest pain should be triaged as ESI level 2. ECG time was abstracted from the original ECG. Analysis of variance was calculated to determine the association between triage levels and time to initial ECG. Results: Two hundred seventy-four patients were enrolled (139 men, 135 women). Patients were triaged accordingly: ESI level 1 (n=0), ESI level 2 (n=209), ESI level 3 (n= 62), and ESI level 4 (n=1). Initial time to ECG per ESI triage category is reported in minutes (mean, SD): ESI level 2 (mean=36, SD=53), ESI level 3 (mean=132, SD=91), and ESI level 4 (mean=137, SD=4). A significant association was found between triage levels and time to ECG (F=55.2, <i>P</i><.01). Bonferroni correction was performed to determine which triage categories were associated with delays to ECG. ESI level 3 patients waited an average of 96 minutes longer (<i>P</i><.01) for an initial ECG compared with ESI level 2 patients. Conclusion: Initial triage level assigned by the triage nurse has a significant impact on time to ECG. Patients who receive a lower triage acuity level sustained a significantly longer delay to initial ECG.