Patients' experiences of triage in an emergency department: A phenomenographic study

Background: Triage, predominantly done by nurses in the emergency department, is globally accepted as essential to prioritise the acuity of patient care. Patients with low acuity illness often express frustration and disgruntlement with the triage process and long waiting times. Consequently, some patients leave the emergency department unseen, which may negatively affect their health outcomes. In order to change practice efficiently, triage nurses should provide patients an opportunity to share their experiences. Objective: This paper deals with exploring the understanding patients' emergency department triage experiences. Design: A phenomenographic approach was used to explore and understand patients' triage-related experiences in an emergency department. Methods and context: Semi-structured individual interviews were conducted with 10 purposively selected participants who were triaged as yellow or green in an emergency department in a public hospital in Botswana. Collaborative creative hermeneutic data analysis by 11 nurses working in the same context identified categories of description. Results: Three categories of description emerged from patient experiences, namely triage environment, triage nurse and waiting times. Following data analysis, the nurses reflected that they were not aware of the consequences in the way triage was currently conducted. Consensus was reached that they should move away from focusing on a biomedical model towards person-centred triage, which then underpinned the outcome space for triage in the emergency department. Conclusion: The reality in the emergency department is that patients' needs, wishes and expectations are neglected, leaving them dissatisfied and disgruntled. Moving towards person- centred triage may improve their overall experience of triage. What is already known about this topic? Globally, triage is implemented in emergency departments to ensure priority identification and management of the sickest and most injured patients first. Patients complain about emergency department triage, particularly prolonged waiting times. Focusing on the biomedical model without patient involvement will result in fragmented, uncoordinated and unsustainable triage. What this paper adds Triage should move away from the biomedical model to being person-centred. Allowing patients to voice their triage experiences would raise awareness of current practice and might influence change. The study highlights the disconnection between patients and triage nurses and the need for attention to patient needs.