TriageNCT05944406
Enhancing Triage Accuracy: A Clinical Audit of the Manchester Triage System Implementation
An observational study of Triage, run by Rawalpindi Medical College at 1 site in Pakistan.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 13 years and older
- Conditions the study is for
- Triage
- What is being tested?
- Educational training of ER Nurses
- How many people
- 494 participants
- Where
- 1 sitePakistan
- Study dates
- 20 Mar 2023to 10 Jun 2023
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 13 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: The study population in this clinical audit consisted of patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi The study population encompassed patients of all age groups and genders who visited the ED during the specified audit cycles and met the inclusion criteria.
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Enhancing Triage Accuracy and Streamlining Emergency Department Services: 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.
Read the detailed description
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.
- Conditions
- Triage
- Being tested
- Educational training of ER Nurses
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Educational training of ER NursesOther
educational intervention was conducted from 2nd to 5th May 2023 with the triage nurses. This intervention comprised of detailed explanations of how the Triage system is accurately used to categorize the patients presenting in the ED and Triage nurses were instructed to refer non-urgent cases to either the Outpatient department or to the Casualty Medical Officer. The results of the first audit were also shared. Additionally, circulars containing instructions regarding accurate usage of MTS were distributed to all triage nurses
| Study group | Role | What they receive |
|---|---|---|
| Audit Cycle 1 | These are the patients included in the first cycle of the clinical audit. The study collected data from a sample of 256 patients who visited the Medical Unit I of Benazir Bhutto Hospital, Rawalpindi, during the specified period. The patients were triaged by the triage nurses using the Manchester Triage System (MTS). Their age, gender, registration time, time of consultation, triage category assigned by the triage nurse, and admission decision were recorded for analysis. The accuracy of triage and waiting times were assessed for these patients. | |
| Audit Cycle 2 | These are the patients included in the second cycle of the clinical audit, conducted after an educational intervention for the triage nurses. The study collected data from a sample of 238 patients who visited the same Medical Unit I of Benazir Bhutto Hospital, Rawalpindi. Similar to audit cycle 1, these patients were triaged using the MTS, and their demographic information, triage category, and admission decision were recorded. The study aimed to evaluate any improvements in triage accuracy and waiting times compared to audit cycle 1 after the intervention and training of the triage nurses. Receives: Other: Educational training of ER Nurses |
What is being measured
The primary outcome is the main question the study is designed to answer.
The number of patients categorized into each triage category by the Triage Nurse
The study aimed to assess how effectively the triage nurses in the Emergency Department (ED) of Benazir Bhutto Hospital, Rawalpindi, categorized patients into different triage categories based on their presenting symptoms. The triage decisions made by the triage nurses were compared with the triage decisions made by the emergency physicians, using the discharge diagnosis as a benchmark. The accuracy of triage was determined by evaluating whether the assigned triage category matched the severity of the patients' condition as indicated by the discharge diagnosis. The study focused on identifying cases of under-triage, over-triage, accurate triage, and un-triage to assess the overall effectiveness of the triage process and to identify areas for improvement.
Measured: 3 months
The number of patients categorized into each triage category by the ER Physician
The patients were categorized into triage categories by the ER Physician upon arrival to doctor (after triage from Triage counter, by the Triage Nurse). This triage was based on the discharge diagnosis and the ER Physician's evaluation.
Measured: 3 months
Secondary outcomes (2)
Number of patients who presented to the ER with cases that didn't require emergency management
A significant portion of the study focused on non-urgent cases that presented to the Emergency Department (ED). These non-urgent cases refer to patients whose medical conditions or symptoms did not require immediate or urgent medical attention. They were evaluated by two independent ER Physicians and labelled 'non-urgent' if they booth sufficiently believed this case required no emergency care and there was no jurgency to get checked by a doctor for the patient. Instead, these cases could have been appropriately managed in the outpatient setting, such as through scheduled appointments in clinics or primary care facilities
Measured: 3 months
Time between patient's arrival to ER and being attended to by the doctor (waiting time) for each triage category
The waiting time each patient spent before they were attended to by the doctor was measured and recorded according to the triage category they belonged to.
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jul 2023
- Study start20 Mar 2023
- Primary completion10 Jun 2023
- Study completion10 Jun 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for TriageStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Enrolment
- 494 participants (actual)
Sponsor and investigators
- Lead sponsor
- Rawalpindi Medical College
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Maham Leeza Adil, Rawalpindi Medical College
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05944406
- Sponsor's protocol ID
- 887456
- Status last verified
- Jul 2023
- First submitted
- 27 Jun 2023
- Last updated
- 13 Jul 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: no plan to share IPD
Study at a glance
From the registry record, last updated by the sponsor on 13 Jul 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Enhancing Triage Accuracy and Streamlining Emergency Department Services: A Clinical Audit of the Manchester Triage System Implementation
- ClinicalTrials.gov ID
- NCT05944406
- Acronym / sponsor ID
- 887456
- Conditions
- Triage
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 494 participants (actual)
- Lead sponsor
- Rawalpindi Medical CollegeUniversity, hospital or other
- Study start
- 20 Mar 2023 (actual)
- Primary completion
- 10 Jun 2023 (actual)
- Study completion
- 10 Jun 2023 (actual)
- First posted
- 13 Jul 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Audit Cycle 1 | – | –These are the patients included in the first cycle of the clinical audit. The study collected data from a sample of 256 patients who visited the Medical Unit I of Benazir Bhutto Hospital, Rawalpindi, during the specified period. The patients were triaged by the triage nurses using the Manchester Triage System (MTS). Their age, gender, registration time, time of consultation, triage category assigned by the triage nurse, and admission decision were recorded for analysis. The accuracy of triage and waiting times were assessed for these patients. |
| Audit Cycle 2 | – | Other: Educational training of ER NursesThese are the patients included in the second cycle of the clinical audit, conducted after an educational intervention for the triage nurses. The study collected data from a sample of 238 patients who visited the same Medical Unit I of Benazir Bhutto Hospital, Rawalpindi. Similar to audit cycle 1, these patients were triaged using the MTS, and their demographic information, triage category, and admission decision were recorded. The study aimed to evaluate any improvements in triage accuracy and waiting times compared to audit cycle 1 after the intervention and training of the triage nurses. |
Who may qualify
- Ages
- 13 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- The study population in this clinical audit consisted of patients who presented to the Emergency Department (ED) of Medical Unit I, Benazir Bhutto Hospital, Rawalpindi The study population encompassed patients of all age groups and genders who visited the ED during the specified audit cycles and met the inclusion criteria.
Key inclusion criteria (4 listed)
- 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.
Key exclusion criteria (5 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Educational training of ER Nurseseducational intervention was conducted from 2nd to 5th May 2023 with the triage nurses. This intervention comprised of detailed explanations of how the Triage system is accurately used to categorize the patients presenting in the ED and Triage nurses were instructed to refer non-urgent cases to either the Outpatient department or to the Casualty Medical Officer. The results of the first audit were also shared. Additionally, circulars containing instructions regarding accurate usage of MTS were distributed to all triage nurses | Other | Audit Cycle 2 |
Primary outcome
The number of patients categorized into each triage category by the Triage Nurse
Time frame: 3 months
The study aimed to assess how effectively the triage nurses in the Emergency Department (ED) of Benazir Bhutto Hospital, Rawalpindi, categorized patients into different triage categories based on their presenting symptoms. The triage decisions made by the triage nurses were compared with the triage decisions made by the emergency physicians, using the discharge diagnosis as a benchmark. The accuracy of triage was determined by evaluating whether the assigned triage category matched the severity of the patients' condition as indicated by the discharge diagnosis. The study focused on identifying cases of under-triage, over-triage, accurate triage, and un-triage to assess the overall effectiveness of the triage process and to identify areas for improvement.
The number of patients categorized into each triage category by the ER Physician
Time frame: 3 months
The patients were categorized into triage categories by the ER Physician upon arrival to doctor (after triage from Triage counter, by the Triage Nurse). This triage was based on the discharge diagnosis and the ER Physician's evaluation.
2 secondary outcomes
Number of patients who presented to the ER with cases that didn't require emergency management
Time frame: 3 months
Time between patient's arrival to ER and being attended to by the doctor (waiting time) for each triage category
Time frame: 3 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Jul 2023.
- Individual participant dataSharing planned: No. no plan to share IPD
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Triage, run by Rawalpindi Medical College at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The number of patients categorized into each triage category by the Triage Nurse (time frame: 3 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jul 2023.