LAUSR

ABSTRACT Introduction: Most emergency departments in rural hospitals practice single-tier triage system. We propose adding a secondary triage, a 2-tier triage system that can improve the department efficacy. Methods: This was a single-centre pre–post-interventional study conducted in a district emergency department. During pre-interventional phase, patients were triaged by usual practice using single-tier system. For post-interventional phase, a secondary triage was added. A physician was also added to the secondary triage during peak hours. All patients who came during pre- and post-intervention phases were recruited for analysis. The primary outcomes were department length of stay (LOS) and left without being seen (LWBS) rate. Results: There were 5007 patients (pre-intervention period) and 4970 patients (post-intervention period) recruited for data analysis. Intervention had reduced the overall LOS from 106 to 85 min (mean, p < 0.001). Subgroup analysis showed reduced LOS for non-critical cases from 72 to 45 min (mean, p < 0.001), but no significant improvement for critical and semi-critical cases. The LWBS rate was also reduced from 4.1% to 2.0% (p < 0.001). Conclusions: Secondary triage system with an addition of physician during peak hours has been proven to improve emergency department LOS and LWBS rate.