Waiting for triage: unmeasured time in patient flow.

Christopher Houston,Kathryn Volz,Richard Wolfe,Christopher Fischer,Leon Sanchez

doi:10.5811/westjem.2014.11.22824

Abstract

IntroductionThe Centers for Medicare and Medicaid Services (CMS) requires reporting of multiple time-sensitive metrics. Most facilities use triage time as the time of arrival. Little is known about how long patients wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is essential to accurately record the time of arrival. Our objective was to quantify the time spent waiting to be triaged for patients arriving to the emergency department (ED).MethodsWe conducted this study in an urban, academic, tertiary care center with approximately 54,000 annual ED visits. All patients arriving to the ED from November 1, 2012, to October 1, 2013, were enrolled. If patients didn’t go directly to a bed or triage, an observer greeted patients as they entered the ED and recorded the time of arrival. The triage time was recorded as normal. We calculated the difference between the arrival time and triage time.ResultsThere were 50,576 patient visits during the study period. Of these, 7,795 (15.4%) patients did not go directly to a bed or triage. For patients who waited for triage, median time from arrival to triage was 11 minutes (IQR 5–19, range 1–105). When stratified by the number of new patients who arrived in the ED in the previous hour, the percentage of greeted patients who waited more than 10 minutes for triage was: 0–5 new patients − 12.4%; 6–10 new patients − 48.8%; 11–15 new patients − 64.4%; 16+ new patients − 68%.ConclusionPatients often waited more than 10 minutes to be triaged. As the number of patients registered in the previous hour increased, the percentage of patients who waited more than 10 minutes for triage increased significantly. During times of peak volume, 8.5% of all patients arriving to the ED waited more than 10 minutes for triage. This wait is not accounted for in the normal reporting of ED throughput times and metrics.

Highlights

The Centers for Medicare and Medicaid Services (CMS) requires reporting of multiple time-sensitive metrics
As the number of patients registered in the previous hour increased, the percentage of patients who waited more than 10 minutes for triage increased significantly
There were patients who had to wait to be triaged at all hours of the day, but the longest wait times occurred between the hours of 10:00 and 20:00, which is when most emergency department (ED) have the highest volume (Figure 1)

Summary

Introduction

The Centers for Medicare and Medicaid Services (CMS) requires reporting of multiple time-sensitive metrics. Requires that hospitals report time-based metrics to evaluate emergency department (ED) performance These include time from arrival to the ED to evaluation by a healthcare provider, to discharge or admission, and to various therapeutic interventions. Triage commonly includes obtaining a chief complaint, vital signs, a brief history, and at times a review of recent ED visits and hospitalizations This detailed triage provides important information but it takes time to perform. If multiple patients arrive simultaneously, there may be a delay in registering patients and recording the time to triage because of queuing This unrecorded wait time prior to triage may cause significant underestimation of timebased metrics

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Discussion

Conclusion