Hospitals are one of the most important parts of healthcare system and responsible for providing services such as assessment, diagnosis, treatment and rehabilitation. Therefore, adequate and accurate hospital functions could improve patient outcomes and early return to a routine life (1). The Emergency Department (ED) is the gateway to the hospital and one of the critical aspects of hospitalization and patient care when faced with major accidents and high risk health conditions. Thus, having highly skilled nursing and medical staffs on duty at all times assures that proper administrative and supervision has been applied to address urgent needs (2).
Undoubtedly, the main and primary role of the ED is to treat critically ill and seriously injured patients (3). Several factors could delay patients' treatment in the ED, such as overcrowding of ED and prolonged waiting time (4). Evidence shows that a long stay in the ED increases patient dissatisfaction due to adverse outcomes. To prevent these possibilities, referred patients to the ED should be immediately triaged and treated (5).
Triage is a vital part of admission and patient management in an emergency room and applied to reduce errors, divide workload, and offer immediate care. A desirable triage system could accurately assess acuity and provide the required urgent care after a correct and timely diagnosis (6).
Appropriate triage plan could increase the quality of care services; increase overall satisfaction, decrease waiting time and hospital stay, reduce morbidity and mortality, increase efficiency and effectiveness of ED services in parallel with the associated costs. In contrast, inefficient triage plan could leads to the loss and waste valuable resources, treatment delays, dissatisfaction and poor health outcomes. Therefore, application of an effective triage system is one of the basic steps for the efficient management of the ED (7).
A wide range of ED triage systems are used in different parts of the world and among them there is a current and popular five-level Emergency Severity Index (ESI). The ESI system is commonly used in hospital emergency departments (8), where patients are divided into five disease severity levels. Level 1 is the most severe and level 5 is the least severe condition (9). The majority of hospitals in the United States and developed countries use the ESI triage system for their patients (10). Research studies have confirmed the accuracy of ESI triage system by triage nurses and other health providers when providing emergency services for patients (6, 11).
One of the most important indicators for performance evaluation of a five-level triage system is noticed the wait time for receiving emergency services, length of stay and patient satisfaction in the ED (12, 13). In particular, the wait time duration in the ED was one of the main components with a significant impact on patient's satisfaction with ED services (13, 14). Other studies have shown that wait time for ED services was directly related to patient satisfaction (5, 15).
While the application of the five-level triage system increases the accuracy of triage process, it does not always produce the best results, especially when the major responsibility for triage is assigned to the "triage nurse" alone (16). The traditional triage model by ED nurse often requires a rapid patient assessment process. Therefore, creative strategies are necessary to improve the time frame for patient assessment upon arrival and admission. One approach is the fast track or a rapid system of triage teamwork system rather than having a single triage nurse (17). Evidence suggests that team work in health care delivery will generate better health outcomes for patient (18).Therefore, it is logical to establish a triage team instead of a triage nurse to improve the triage accuracy, which is, of course, the focus of this investigation.
Due to the importance of waiting time to receive services, length of stay and patient satisfaction at the ED, researchers examined various interventions and found the creation of a triage team of nurses and physicians was the best approach (16, 19). These studies indicated that a triage team of nurses and physicians fulfilled performance criteria by shorter waiting time, length of stay and patient satisfaction. Other studies in this area have reported contradictory results (20–22). The importance of patient triage in ED for a better patient outcome can be accomplished by using innovative evidence-based methods and because the subject of team triage model has not been examined in Iran, therefore the aim of this study was to investigate the effect of team triage method on ED performance indexes.