JMIR Publications

ABSTRACT

Background:

The use of triage systems such as the Manchester Triage System is a standard procedure to determine the sequence of treatment in emergency departments. When using the Manchester Triage System, time targets for treatment are determined. These are commonly displayed in the emergency department information system to emergency department staff. Using measurements as targets has been associated with a decline in meeting those targets.

Objective:

We investigated the impact of displaying time targets for treatment to physicians on processing times.

Methods:

We analyzed the effects of displaying time targets to emergency department staff on waiting times in a prospective cross-over study during the introduction of a new emergency department information system. The old information system version used a module that showed the time target determined by the Manchester Triage System, while the new system version used a priority list instead.

Results:

The average emergency department length of stay and waiting times increased when using an emergency department information system that did not display time targets (time from admission to treatment t ̅pre = 15 min., IQR = 6-39, t ̅post = 11 min., IQR = 5-23). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in pre-intervention for MTS1, only 0.49 as high for MTS2). Furthermore, patients with severe injuries were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred.

Conclusions:

Our results suggest that it is beneficial to use a priority list instead of displaying time targets to emergency department personnel. Time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.