ANALYSIS OF DATA AND FINDINGS

The questionnaire was sent to the sister‑in‑charge of all 36
A/E departments in the Republic of
Ireland. 34 questionnaires were returned (Table 1).
Table 1
Questionnaires sent

Questionnaires
  returned 

Percentage
  returned 
  36 
35 
97.2%
I was researching the availability of a formal triage system in the A/E departments. From experience I know that if there isn't a formal triage service patients are still prioritized according to their illness and a number of departments included notes to that effect. The result was 12 (34.2%) of A/E departments in Ireland operate a triage system (Table 2).
Table 2
Availability of triage in A/E departments.
N*
%
Triage in operation
12
34.2
No Triage in operation
23
67.7

(* Please note 'N' refers to number)

2 departments are currently looking into the establishment of a triage system. Most A/E departments 12 (52.1 % ) stated that lack of space and staff were the reasons triage was not in operation. But 2 (8.6%) of departments thought it unnecessary (Table 3).
Table 3
Reasons triage is not in operation
N*
%
Lack of space and staff
12
52.1
Lack of space only
6
26.0
Lack of staff only
3
13.0
Unnecessary
2
8.6
I wanted to have some background information on the hospitals involved to see if that influenced the availability of triage. I felt that it was more likely that teaching hospitals would have triage. 20(57.19 ) of hospitals classified themselves as teaching hospitals (table4)

Back to top
Table 4
Classification of hospitals
N*
%
Teaching
20
57.1
Non-teaching
15
12.8
On analysis I found that 11(55 % ) of hospitals that classified themselves as teaching hospitals have triage. Only 1(6.6 96 ) of the non-teaching hospitals operate triage (table 5)
Table 5
Triage in and non teaching hospitals
N*
%
Teaching hospital with triage
11
55.0
Teaching hospital without triage
9
45.0
Non-teaching hospital without triage
1
7.1
Non-teaching hospital with triage
13
92.8
The majority of hospitals with A/E departments had between 100-300 beds (table 6)
Table 6
Hospital bed capacity
N*
%
< 100
7
20.0
100 ‑ 300
15
42.8
 300 ‑ 500      
9
25.7
500 ‑ 700  
3
8.5
> 700 
1
2.8

The average number of patients per annum attending the A/E departments fell into 3 main groups
10,000‑20,000 patients
20,000‑30‑000 patients
40,000 patients
Table 7
Average number of patients per annum attending the Accidents and Emergency department
Number of patients
N*
%
< 10,000  
1
11.4
    10,000 ‑ 20,000 
10
28.5
20,000 ‑ 30,000 
7
20.0
30,000‑40,000  
6
17.1
40,000
8
22.8

I felt that hospitals with large bed numbers were more likely to have a larger number of patients
per annum in the A/E.(tables 8‑12)
 An incidental finding was that while 5 (55.5 % ) of hospitals with 300‑500 beds saw > 40,000 patients a year in A/E, 2 (22.2 %) of these hospitals saw 20,000‑30,000 patients per annum in A/E. While 1 (14.2 % ) hospital with < 100 beds also saw between 20,000 ‑30,000 patients per annum in A/E.

Table 8 
   Hospitals with < 100 beds
Number of patients per annum in A/E    
N*
%
<                 10,000   
1
14.2
10,000 ‑ 20,000  
5
71.4
20,000 ‑ 30,000    
1
14.2

Table 9                                             
  Hospitals with 100 ‑ 300 beds
Number of patients per annum in A/E      
N*
%
<               10,000     
1
6.6
10,000 ‑ 20,000   
7
46.6
20,000 ‑ 30,000  
4
26.6
30,000 ‑ 40,000 
3
20.0

Table 10                                            
Hospitals with 300 ‑ 500 beds
Number of patients per annum in A/E
N*
%
20,000 ‑ 30,000  
2
22.2
30,000 ‑ 40,000  
2
22.2
>                 40,000    
5
55.5

Table 11                                            
Hospitals with 500 ‑ 700 beds
Number of patients per annum in A/E      
N*
%
30,000 ‑ 40,000  
1
33
>                 40,000    
2
66

Table 12                                            
Hospitals with > 700 beds
Number of patients per annum in A/E     
N*
%
>                 40,000
1
100

I felt tat triage was more likely to a available in departments with large numbers o patients per
year, e.g. over 30,000 patients, but on analysis only 3 (50%) A/E departments with 30,000 ‑ 40,000
patients per annum had triage. 6 (75 %) of A/E departments with 40,000 patients per annum had triage (Table 13).

Back to top
 
Triage
Table 13
Relationship between the numbers of patients in A/E per annum and the availability of triage.
N*
%

No Triage

N*

 

%
<      10,000  
0
0
10,000 ‑ 20,000        
1
8.3
20,000 ‑ 30,000   
2
28.5
30,000 ‑ 40,000    
3
50.0
>   40,000
6
70.0
 
7
100
11
91.6
5
71.4
3
50.0
2
25.0
   
Table 14 shows the number of AfE departments with consultants in A/E medicine

Table 14
Number of A/E departments with A,/E consultant

N*

%
Full time A/E consultants 
15
42.8
A visiting A/E consultant 
3
8.5
No A/E consultant 
17
48.5
As I stated earlier, I was of the opinion that if there was an A/E consultant in the department there was a greater possibility that triage would be available. This is proved in Table 15.

Table 15
Triage in A/E departments in relation to the presence of A/E consultant

N*

%
Triage and A/E consultant   
11
73.3
No triage and A/E consultant  
4
26.6
Triage and no consultant  
1
5.2

................ As can be seen from Table 15 only 1 (5.2%) AIE departments in the country that does not have an A/E consultant operates triage, while 11 (73.3 % ) of A/E departments with consultants have triage.An incidental fording was that A/E consultants only work in departments with greater than 20,000 patients per annum, but the majority work in departments with more than 40,000 patients per

annum. Only 1 (16.6%) A/E departments with 30,000 ‑ 40,000 patients per annum still does not have an A/E consultant (Table 16).
 
With Consultants
Without Consultant
Table 16
Table 16 Relationship between the number of patients per year in the A/E and the presence of a consultant.

N*
%

N
%
<            10,000        
0
0
4
100
10,000 ‑ 20,000 
0
0
10
100
20,000 ‑ 30,000  
2
28.5
5
71.4
30,000 ‑ 40,000  
8
100
0
0
>            40,000  
6
75
2
25
I thought triage was relatively new to Ireland, but 10 (83.3 % ) of those departments with triage have
it more than 3 years (Table 7)

Table 17
Length of time triage is operating

N*

%
<             1 year   
0
0
1 ‑          2 years  
1
8.3
2 ‑          3 years 
1
8.3
>            3 years 
10
83.3

I wanted to see if a full 24 hour triage service was provided in each of the A/E departments with triage.

Only 5 (41.6 % ) of departments provide 24 hour cover, 1 (8. 3 % ) of these departments stated that the service may be limited between 20.00 hours and 06.00 hours due to staffing levels. 2 (16.6%) of the departments that provide 8 hour cover stated that they try to provide 12 hours when possible (Table 18)

Table 18
Number of hours triage is provided per day

N*

%
24 hours   
5
41.1
12 hours 
3
25.0
8 hours  
4
33.3
The numbers of triage categories used varied from none to 6. One department did not complete this question. One (9%) department ticked 'others' saying they prioritize patients according to their illness (Table 19). The recommended number of triage categories in both the UK (3.4) and Australia is 5 (6), no Irish A/E department uses this number.
Table 19
Number of triage categories used

N*

%
3
4
36.3
4
5
45.4
5
0
0
6
1
9.0
Others
1
9.0

In 5 (41.6%) of departments the triage nurse sees all patients.

In 7 (58.3%) of departments she sees non-ambulance patients (Table 20
Table 20
Patients seen by triage nurse

N*

%
Non-ambulance patients
7
58.3
All ambulance and non-ambulance patients 5
5
41.6
I did expect that every department would have a written policy on triage, but I was surprised when 6(54.5 % ) of A/E departments did not have a written triage policy. (table 21). One department did not complete this question.

Table 21
Written policy on triage

N*

%
Written policy     
5
45.4
No written policy  
6
54.5
The facilities available for triage varied but 6 (50 % ) of A/E departments had public areas for triage (table 22). A public area for triage is better than no triage at all, but it makes it impossible to fully examine or interview patients in front of a waiting room full of patients. One department with a public area for triage has plans submitted and approved for a private triage area.

Back to top

Table 22
Physical facilities available for triage

N*

%
Private area 
3
25
Semi‑private area   
3
25
Public area   
6
50
An area of great importance is who works in triage (table 23), what if any A/E experience
  is necessary (table 24 + 25 ) and what training is required (table 26)

Table 23
Designated triage nurse Vs all RGN's working in triage

N*

%
Designated triage nurse        
5
44.1
All RGN's
7
53.8
Two (16. 6 % ) of A/E departments replied that no prior A/E experience was necessary to work in triage (table 24). One (8.3 %) of these stated that while no experience was necessary new nurses aren't allocated to triage for some weeks and senior nurses will cover as much as possible. This is very alarming as it has been agreed upon in the literature that  triage should be carried out by a senior, experienced nurse (1,3,5,6,7,11).Recommendations for experience vary from 6 months to 3 years (1).

Table 24
A/E experience necessary to work in triage

N*

%
Yes   
10   
83.3
No 
2
16.6
Table 25
Amount of_A/E experience necessary to work in triage

N*

%
6 months  
6
60
1 year    
0
0
2 years 
1
10
> 2 years     
3
30
Training requirements to work in triage varied (table 26). One (8.3 % ) department stated
that a formal orientation course was necessary and an A/E nursing course was preferable.
5 (41. 6 % ) of departments provided a formal orientation course, with a further 5 (41. 6 % )
providing informal training.

Table 26

Training necessary to work in triage

N*

%
A/E nursing course 2 16.6
Formal orientation course  5 41.6
Informal training     5 41.6
The skilled tasks that could be initiated by the triage nurse varied hugely between departments. This is probably influenced by the fact that 6 (50 % ) of departments have a public area for triage. In only 1 (8.3 % ) department could the triage nurse initiate all the listed tests. In 2 (16. 6 % ) of departments the triage nurse could only initiate an ECG (table 27). 1 (8.3 % ) department stated that in 1997 the triage nurse will be able to initiate X Ray examinations.

Table 27
Skilled tasks performed by the triage nurse

N*

%
Initiate ECG  
7
58.3
Initiate laboratory studies 
6
50
Initiate X Ray examinations 
3
25
Initiate pregnancy tests   
5
41.6
Initiate visual acuity testing  
2
16.6
None  
2
16.6