The effect of crowding in emergency department on precheck triage

Abstract

Objective To explore the influence of crowding in emergency department on precheck triage. Methods Data of 126 078 patients admitted to the emergency department of the hospital from January 2017 to June 2017 were retrospectively analyzed. According to the occupancy rate of emergency beds, the patients were divided into crowded group and non-crowded group.The epidemiological data, number of patients waiting for triage, waiting time for triage, length of stay(LOS), delayed triage rate, missed triage rate, missed triage rate of critically ill patients, over triage rate of critically ill patients, disease level, years of service in triage of nurses and the flow of triage were compared between the two groups. Linear regression and Logstic regression were used to analyze patient wait triage, LOS, and factors influencing patient diversion to the clinic. Results The delayed rate of triage, missed rate and missed rate of critical patients in the crowded group were significantly higher than those in the non-crowded group, with statistically significant differences(P<0.01). There was no statistically significant difference in triage accuracy and overtest rate among critically ill patients. Waiting time for triage was significantly correlated with the number of waiting patients and the length of service of triage nurses (P<0.01). LOS was significantly positively correlated with the number of patients waiting for triage (P<0.001), and was negatively correlated with the triage nurse triage work year limit (P<0.001). They have nothing to do with the patient's age, disease level and gender.The working years of the triage nurse and the patients in the low age group were the influencing factors for the diversion to the outpatient service (P<0.001). The number of patients waiting for triage and gender were not the influencing factors. Conclusions Crowding in the emergency department causes many adverse effects on pre-diagnosis triage, leading to the extension of waiting time for triage and LOS, increasing the rate of missed tests in critically ill patients, which is not conducive to patient safety and brings hidden dangers to medical care. Therefore, it should be attached great importance to improve its negative effect on triage. Key words: Emergency department crowding; Pre-diagnosis triage; Missed rate; Triage accuracy