The Triage System

Triage is a process that is critical to the effective management of modern emergency departments. 

Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. 

Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking.

Triage is an essential element of modern medical care as it is necessary to assign relatively scarce resources to unlimited medical needs. Such assignments become necessary where there is a mismatch in quantum, time or location between the medical needs of patients and available resources.

In emergency medicine this mismatch relates to the timeliness of care and relative resource availability. Emergency medicine, like military medicine, has little control over the rate and number of presentations. Although patient numbers are predictable at the population level, they are not predictable at the individual level. Further description of workloads by triage categories adds weight to the predictability of patient populations. In addition, major events can lead to sudden overwhelming demand. 

Triage in emergency healthcare is a continuous process, but is also emphasised at key points in the continuum of care. These points include extrication from the scene, on arrival at the ED, upon admission to hospital and on presentation to operating theatres.

Triage systems are designed to serve the value of human life and health with fairness and the efficient use of resources. They do this by determining who will not be disadvantaged by longer waiting times and who requires immediate attention to achieve optimal outcomes. The need for triage is enhanced by the growing imbalance between needs and resources resulting from the twin challenges of access block and growing demand.

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