The effects of patient triage management strategies on clinical outcomes and risk management in emergency departments: a prospective comparative study

Abstract

Aims: The aim of this study is to compare the impact of the emergency severity index (ESI) and the Manchester triage system (MTS) on clinical outcomes, patients' satisfaction, and risk management using a prospective approach. Methods: In this study, which includes 12,000 patients who visited the emergency department of Esenyurt Necmi Kadıoğlu State Hospital between September 1, 2024, 2024, and October 15, 2024, 6,000 patients were triaged using the ESI, and 6,000 patients were triaged using the MTS. The study was conducted by randomly selecting patients between the ages of 18-85 who were visiting the emergency department for the first time. Data were collected using the observations of healthcare personnel, electronic health system data, and patient admission records. The primary variables include treatment times, clinical outcomes, resource utilization in the emergency department, and patient waiting times. Surveys were used to measure patients' satisfaction, and medical inaccuracies were evaluated based on error reports and inconsistencies in medical records. Statistical analyses were performed using SPSS software, applying independent sample t-tests, chi-square tests, and logistic regression analyses. Results: It was found that patients triaged using the ESI had significantly lower waiting times compared to those triaged using the MTS (OR: 0.65, 95% CI: 0.50-0.85, p<0.05). Mortality rates in the ESI group were also significantly lower compared to the MTS group (OR: 0.72, 95% CI: 0.55-0.92, p<0.05). In terms of complication rates, patients triaged with ESI also showed a significant reduction compared to those triaged with MTS (OR: 0.60, 95% CI: 0.45-0.80, p<0.01). ESI-triaged patients showed a significant improvement in resource utilization compared to patients triaged using MTS (OR: 0.70, 95% CI: 0.55-0.88, p < 0.05). Patient satisfaction results also showed a significant difference in favor of ESI (OR: 1.50, 95% CI: 1.25-1.80, p<0.001). Medical errors and legal issues were observed to be less frequent among patients triaged with ESI, a finding that was significant in terms of risk management (OR: 0.55, 95% CI: 0.40-0.75, p<0.05). Conclusion: The use of the ESI as a triage method may be an effective approach for reducing medical inaccuracies, mortality, and complication rates, as well as optimizing emergency department management. These findings suggest the need for reviewing triage systems in clinical practice and expanding the use of ESI. I believe that incorporating ESI, a triage method that enhances patients' satisfaction and optimizes resource utilization, into future emergency department management is crucial.

Keywords

• Emergency severity index
• Manchester triage system
• clinical outcomes
• risk management
• patient satisfaction
• medical error

Supporting Institution

: There is no financial support or conflict of interest. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare no financial support or conflicts of interest. They also confirm that they have no financial relationships with any companies and have received no external funding.

Ethical Statement

İSTANBUL MEDİPOL ÜNİVERSİTESİ GİRİŞİMSEL OLMAYAN KLİNİK ARAŞTIRMALAR ETİK KURULU TOPLANTI TARİHİ: 12/09/2024 KARAR NO: 898

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