Implementation of the Spanish Triage System in the emergency departments of public health service hospitals in Andalusia, Spain

Objective. To describe the process of implementing the Spanish Triage System (SET, in its Spanish abbreviation) in nonspecialist hospital emergency departments (EDs) in the public health service. Methods. Multicenter cross-sectional study at 4 time cut-points (6 months before implementation and at the end of 1, 2 and 3 semesters afterwards). The study was carried out in 29 public hospital EDs in Andalusia. We recorded the following data: type of hospital, proportion of cases in which the SET was applied, priority classifications assigned on triage, wait time before triage, and duration of the triage process. We also recorded the following proportions: patients waiting less than 10 minutes for the assigned priority, cases with a triage processing time less than 5 minutes, ED revisits within 72 hours, ED deaths, and patients leaving before discharge. Results. We saw SET use increase progressively over the 3 semesters. The mean wait time decreased, and the proportion of patients waiting less than 10 minutes increased. The mean triage processing time tended to decrease nonsignificantly as the proportion of cases triaged in less than 5 minutes rose. The proportion of patients leaving before discharge increased with time; in overall and by hospital type. The proportion of ED deaths did not change significantly, and revisits within 72 hours increased only in more complex hospitals (P = .019). Conclusion. Implementing a structured triage approach like SET is a gradual process. Quality indicators must be followed over time so that the impact of a triage system on ED care processes can be assessed.