Performance of the rapid triage conducted by nurses at the emergency entrance.
Bruna Roberta Siqueira Moura, Lilia de Souza Nogueira
PMID 33084778WHAT IT FOUND
Nurses' rapid triage at the emergency entrance missed fewer critically ill patients than the Manchester Triage System but sent more non-critical patients to the emergency room.
It was better at predicting who did not need observation unit admission.
Key findings
01Rapid triage had lower undertriage and higher overtriage rates than the Manchester Triage System across all evaluated scenarios.
02Rapid triage performed better than the Manchester Triage System in predicting which low-priority patients would not be admitted to the emergency observation unit.
03A patient classified as low priority by rapid triage subsequently died in the intensive care unit after being classified as orange (very urgent) by the Manchester Triage System.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted in a single secondary-level hospital in Brazil, so the results may not generalize to other emergency departments with different resources or patient populations. There is no clear gold standard for rapid triage, so the researchers had to use proxy outcomes like length of stay and ICU admission to judge accuracy. The sample consisted only of patients who reported severity upon arrival, meaning they were potentially sicker than the general emergency population, which may inflate mortality rates and triage discrepancies. The number of ICU beds was limited (12), which may have influenced admission decisions and the apparent performance of the triage systems in predicting ICU need.
Declared interests
The study was approved by the Research Ethics Committee, and informed consent was obtained from nurses and patients. The text does not explicitly state funding sources or commercial conflicts of interest.
The easy way to misread this
Do not conclude that rapid triage is superior to the Manchester Triage System overall. While it missed fewer serious cases, it significantly overtriaged, sending more non-critical patients to emergency care, which worsens overcrowding and wastes resources. The study did not prove rapid triage is safer or more efficient than standardized protocols.