Emergency department(ED) overcrowding prolongs the waiting time, delays the treatment of severely ill patients, and deprives the quality of ED care. In our hospital, pediatric patients are over 30% of all ED patients and are main cause of the
overcrowding. For solving this problem, the pediatric patients were classified along symptom severity by a triage criteria, modified from Brooks Army Hospital, TX, USA, Feasibility and safety for using the criteria were evaluated with comparing
the
triage and ED outcome, .and with follow-up of nonemergent patients by review of admission and out-patient record and by phone two weeks after ED visits.
Six hundred fifty four pediatric patients were triaged by intern for 3 months period. Three hundred twenty(48.9%) were classified as nonemergency. Correspondence rate of triage and ED outcome was 60.6%, overtriage rate 33.6%, and undertriage rate
was
5.8%. The safety of the criteria was 94.2%.
Among 320 nonemergency, four cases(1.3%) admitted via ED and outpatient clinics, but three admission through outpatient clinics were supposed to have proper triage and adequate management in ED. Therefore, mistriage rate was only 0.3%(1/320).
Nonemergency rate of pediatric patients was 41.1% in weekday and 60.2% in Sunday, and less than 30% in daytime and nearly 50% in night time.
These results suggest that the criteria can be used for pediatric triage with reliable safety. ED overcrowding would be reduced by implementation of new patients flow system along the pediatric triage, especially on night time and Sunday. The
triage
criteria should be improved by developing more objective criteria and follow-up method.
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