Is it possible to safely increase the number of patients classified as non-urgent in triage? A prospective observational study


Submitted: 2 October 2023
Accepted: 11 December 2023
Published: 19 January 2024
Abstract Views: 1274
PDF: 136
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Authors

  • Arian Zaboli Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bozen, Italy. https://orcid.org/0000-0002-4204-8884
  • Serena Sibilio Hospital of Merano-Meran (SABES-ASDAA), Department of Emergency Medicine, Merano, Italy.
  • Michael Mian Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano; College of Health Care-Professions Claudiana, Bozen, Italy. https://orcid.org/0000-0003-2539-5996
  • Francesco Brigo Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bozen, Italy.
  • Gianni Turcato Hospital of Santorso (AULSS-7), Department of Internal Medicine, Santorso, Italy.

Triage systems, calibrated to discriminate acute conditions, seem unable to deal with minor non-urgent conditions. The aim of the present study to verify whether some level 4 priority codes can be safely declassified to level 5 priority codes. A prospective observational study was performed between 1° October 2022 to 31° March 2023. All patients with a code 5 according to the Manchester Triage System (MTS) were compared with patients with a priority level 4 code but with a general indicator that was downgraded to a code 5 after the triage nurse's assessment. Of the 2032 patients enrolled, 58.6% were part of the 'blue from MTS' group while 41.4% were part of the 'blue after re-evaluation' group. There was no statistical difference in the rate of hospitalisation and discharge between the two groups (p=0.928). There was also no difference between the two groups in the comparisons of short- and medium-term death. This study highlights the need to rethink strategies to declassify patients through MTS, especially given the continuous increase of non-urgent patients presenting in the ED.


Tang N, Stein J, Hsia RY, et al. Trends and characteristics of US emergency department visits, 1997-2007. JAMA 2010;304:664-70. DOI: https://doi.org/10.1001/jama.2010.1112

Bardelli P, Kaplan V. Non-urgent encounters in a Swiss medical emergency unit. Swiss Med Wkly 2013;143:w13760. DOI: https://doi.org/10.4414/smw.2013.13760

Morley C, Unwin M, Peterson GM, et al. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018;13:e0203316. DOI: https://doi.org/10.1371/journal.pone.0203316

Gonçalves-Bradley D, Khangura JK, Flodgren G, et al. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst Rev 2018;2:CD002097. DOI: https://doi.org/10.1002/14651858.CD002097.pub4

Gräff I, Goldschmidt B, Glien P, et al. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability. PLoS One 2014;9:e88995.

Kemp K, Alakare J, Kätkä M, et al. Accuracy of Emergency Severity Index in older adults. Eur J Emerg Med 2022;29:204-9. DOI: https://doi.org/10.1097/MEJ.0000000000000900

Zaboli A, Sibilio S, Cipriano A, et al. Italian validation of the Manchester Triage System towards short-term mortality: a prospective observational study. Emerg Care J 2023;19:11443 DOI: https://doi.org/10.4081/ecj.2023.11443

Hinson JS, Martinez DA, Cabral S, et al. Triage Performance in Emergency Medicine: A Systematic Review. Ann Emerg Med 2019;74:140-52. DOI: https://doi.org/10.1016/j.annemergmed.2018.09.022

Zaboli A, Ausserhofer D, Pfeifer N, et al. Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system's validity. J Clin Nurs 2021;30:942-51. DOI: https://doi.org/10.1111/jocn.15635

Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the Emergency Department Assessment of Chest Pain Score on the Triage Performance in Patients With Chest Pain. Am J Cardiol 2021;161:12-8. DOI: https://doi.org/10.1016/j.amjcard.2021.08.058

Mackway-Jones K, Marsden J, Windle J. Manchester Triage System. Zanichelli; 2017.

Grosgurin O, Cramer B, Schaller M, et al. Patients leaving the emergency department without being seen by a physician: a retrospective database analysis. Swiss Med Wkly 2013;143:w13889. DOI: https://doi.org/10.4414/smw.2013.13889

Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med 2018;18:58. DOI: https://doi.org/10.1186/s12873-018-0215-0

Goodridge D, Stempien J. Understanding why older adults choose to seek non-urgent care in the emergency department: the patient's perspective. CJEM 2019;21:243-8. DOI: https://doi.org/10.1017/cem.2018.378

Lowthian JA, Smith C, Stoelwinder JU, et al. Why older patients of lower clinical urgency choose to attend the emergency department. Intern Med J 2013;43:59-65. DOI: https://doi.org/10.1111/j.1445-5994.2012.02842.x

Bahadori M, Mousavi SM, Teymourzadeh E, et al. Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions. BMJ Open 2020;10:e028257. DOI: https://doi.org/10.1136/bmjopen-2018-028257

Gilbert A, Brasseur E, Petit M, et al. Advanced triage to redirect non-urgent Emergency Department visits to alternative care centers: the PERSEE algorithm. Acta Clin Belg 2022;77:571-8. DOI: https://doi.org/10.1080/17843286.2021.1914948

Uthman OA, Walker C, Lahiri S, et al. General practitioners providing non-urgent care in emergency department: a natural experiment. BMJ Open 2018;8:e019736. DOI: https://doi.org/10.1136/bmjopen-2017-019736

Gräff I, Latzel B, Glien P, et al. Validity of the Manchester Triage System in emergency patients receiving life-saving intervention or acute medical treatment-A prospective observational study in the emergency department. J Eval Clin Pract 2019;25:398-403. DOI: https://doi.org/10.1111/jep.13030

Platts-Mills TF, Travers D, Biese K, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med 2010;17:238-43. DOI: https://doi.org/10.1111/j.1553-2712.2010.00670.x

Zaboli A, Ausserhofer D, Sibilio S, et al. Nurse triage accuracy in the evaluation of syncope according to European Society of Cardiology guidelines. Eur J Cardiovasc Nurs 2022;21:280-6. DOI: https://doi.org/10.1093/eurjcn/zvab063

Parenti N, Reggiani ML, Iannone P, et al. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud 2014;51:1062-9. DOI: https://doi.org/10.1016/j.ijnurstu.2014.01.013

Chen W, Linthicum B, Argon NT, et al. The effects of emergency department crowding on triage and hospital admission decisions. Am J Emerg Med 2020;38:774-9. DOI: https://doi.org/10.1016/j.ajem.2019.06.039

Mackway-Jones K, Marsden J, Windle J. Emergency triage: Manchester Triage Group, Third edition. John Wiley & Sons, Ltd, West Sussex; 2014. DOI: https://doi.org/10.1002/9781118299029

Brutschin V, Kogej M, Schacher S, et al. The presentational flow chart "unwell adult" of the Manchester Triage System-Curse or blessing? PLoS On 2021;16:e0252730. DOI: https://doi.org/10.1371/journal.pone.0252730

Christ M, Grossmann F, Winter D, et al. Modern triage in the emergency department. Dtsch Arztebl Int 2010;107:892-8. DOI: https://doi.org/10.3238/arztebl.2010.0892

Zachariasse JM, van der Hagen V, Seiger N, et al. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open 2019;9:e026471. DOI: https://doi.org/10.1136/bmjopen-2018-026471

Gräff I, Goldschmidt B, Glien P, et al. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability. PLoS One 2014;9:e88995. DOI: https://doi.org/10.1371/journal.pone.0088995

Zaboli, A., Sibilio, S., Mian, M., Brigo, F., & Turcato, G. (2024). Is it possible to safely increase the number of patients classified as non-urgent in triage? A prospective observational study. Emergency Care Journal, 20(1). https://doi.org/10.4081/ecj.2024.11904

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