Prevalence and causes of mistriage using the example of a university emergency department Process analysis and optimization based on the Manchester Triage System

Background Emergency departments in Germany are confronted with increasing numbers of patients. In order to manage the growing demand for medical care, standardized triage systems have been introduced throughout the country and are required by law. Objectives After implementation of the Manchester Triage System in the surgical emergency department of a supraregional trauma center, there were indications of relevant mistriage. This paper investigates the prevalence and causes of mistriage and shows possible countermeasures. Materials and methods The cross-sectional study included two study arms: a prospective process observation and a retrospective case analysis of triage episodes. Results Of 14,156 patients treated during the observation period, 497 triage episodes were prospectively observed and 720 triage episodes were retrospectively examined. In all, 51.6% of the urgency level "Red" and 37.1% of "Blue" were incorrectly triaged. Possible causes were found in the areas of user ("Red": 88.9%, "Blue": 85.7%), process organization ("Red": 91.9%, "Blue": 12.8%) and the triage system ("Red": 8.1%, "Blue": 15.8%). Conclusion The study shows the presence of a relevant mistriage and implies that even a standardized triage system needs to be reviewed and integrated into existing structures after implementation. Mistriages seem to be multifactorial. Different possible sources of errors are mutually dependent and lead to incorrect assessments. This should not be countered with single measures, but with a package of measures to make triage safe and efficient.