Emergency department crowding affects triage processes

Introduction: During emergency department (ED) crowding there is an imbalance between the need for emergency care and available resources. We assessed the impact of crowding on the triage process. Methods: A 1-year health records review of 49,539 patient visits was performed. Data extracted included: occupancy ratio, ED occupancy, demographics, length of stay (LOS), time to triage, triage score, years working as a triage nurse, and triage destination. Data were analyzed using descriptive statistics and regression analyses. Results: During crowding, target times to triage elapsed more often than during non-crowding (49.7% vs. 24.9%, P < 0.001), and more patients were not triaged (2.2% vs. 1.6%, P < 0.001). A higher ED occupancy was associated with longer waiting times for triage and longer LOS (P < 0.001). There were 12,627 (25.5%) patients redirected to the general practitioner cooperative (GPC). No association between level of crowdedness and number of patients who were redirected to the GPC was found (P = 0.122). Redirection to the GPC occurred significantly more often when the triage nurse had more years working as a triage nurse (P < 0.001). Conclusion: At this hospital, crowding affects the triage process, leading to longer waiting times to triage and longer ED LOS. Crowding did not influence triage destination. (C) 2016 Elsevier Ltd. All rights reserved.