Enhancing Triage Accuracy: A Clinical Audit of the Manchester Triage System Implementation

This clinical audit focused on improving how patients are prioritized and managed in the emergency department. The audit took place in a hospital in Rawalpindi and involved two cycles of data collection. The results showed that after an educational intervention, there was an improvement in accurately triaging patients and a decrease in cases that were categorized as urgent when they were not. The audit also revealed a decrease in non-urgent cases visiting the emergency department. The findings highlight the importance of proper training, following triage guidelines, and referring non-urgent cases to other departments. The suggestions include improving the triage process and making the emergency department more efficient for better patient care.

This clinical audit aimed to assess the accuracy and effectiveness of the Manchester Triage System (MTS) implementation in a hospital's emergency department. The audit took place in Medical Unit I of Benazir Bhutto Hospital, Rawalpindi, over two cycles from March to June 2023.

The hospital, affiliated with Rawalpindi Medical University, is a 750-bed tertiary care facility located in a busy city. The emergency department, equipped with approximately 91 beds, follows triage guidelines established by the hospital. The triage process involves categorizing patients based on their presenting problem and determining the time within which they should be evaluated and treated by a doctor.

To conduct the audit, certain standards were set before assessing the triage process. These included ensuring guidelines on patient categorization into triage categories, using a standard triage box in the patient record sheet, setting waiting time limits for each category, and using the discharge diagnosis of the doctor as a benchmark for triage accuracy.

The audit involved two cycles: the first from March to April 2023 and the second from May to June 2023. Convenience sampling was used to select a sample size of 256 patients for the first cycle and 238 patients for the second cycle. Data collection involved recording patient demographics, registration and consultation times, triage categories assigned by the triage nurse, admission decisions, and independent assessment of triage accuracy by a pair of doctors.

After completing the first cycle, an educational intervention was conducted with the triage nurses, providing detailed explanations on accurate usage of the MTS and instructing them to refer non-urgent cases to the outpatient department or the Casualty Medical Officer. Circulars containing instructions regarding MTS usage were also distributed. The second cycle was then conducted, following the same data collection procedure.

Eligibility Criteria:
Inclusion Criteria:

* Patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi.
* Patients whose data was recorded and available for analysis.
* Patients of all age groups and genders.
* Patients who visited the ED during the specified audit cycles.

Exclusion Criteria:

* Children (age\<13 years)
* Patients whose data was incomplete or missing crucial information for analysis.
* Patients who were not seen by a doctor and did not receive a discharge diagnosis.
* Patients who visited the ED outside the specified audit cycles.
* Patients who were transferred to another facility before receiving triage or medical assessment.