Robustness and Effectiveness of the Triage System in the Pediatric Context

Background The increasing use of emergency departments (EDs) potentially compromises their effectiveness and quality. The evaluation of the performance of the triage code system in a pediatric context is important because waiting time affects the quality of care for acutely ill patients. Objective In this study, we aimed to assess the effectiveness and robustness of the triage code system in a pediatric context and identify the determinants of waiting times for urgent and non-urgent patients. Methods Data regarding 37,767 pediatric patients who accessed the ED of a major Italian pediatric hospital in 2015 were investigated in order to study patient numbers and waiting times. The determinants of waiting times for urgent and non-urgent patients, as well as variables referring to the "supply side,'' such as periods of staff shortage, were analyzed using a survival analysis framework. Results For urgent patients, the waiting time between triage and the first physician assessment is generally below the standard threshold of 15 min and this is not affected by the number of non-urgent patients waiting for care. Conversely, the waiting time for non-urgent patients is affected by ED flow, periods of staff shortage, and non-clinical variables (age and nationality). Conclusion Our results suggest that the triage level assignation system is effective in terms of safety for urgent patients. The current ED organization adequately fulfills its primary goal of providing healthcare for acutely ill patients.