Reduced overtriage is associated with increased patient flow at pediatric emergency department

Abstract Background Crowding is the major threat to patient safety at pediatric emergency departments (PED) and a slow patient flow is its main contributor. Overtriage may impair patient flow, requiring triage systems to balance undertriage-overtriage risks. To reduce overtriage, RETTS-p was replaced by WEST-P at Gothenburg’s PED in 2021. No prior studies compare pediatric triage systems’ impact on patient flow. Our objective was to compare patient flow from different triage systems with different levels of overtriage. Methods This retrospective, observational study was performed at Queen Silvia PED in Gothenburg, Sweden. Triage urgency and patient flow metrics were collected in March 2018, 2019 (RETTS-p), 2022 and 2023 (post-WEST-P implementation). All triaged patients assessed by a physician were included. Patient inflow and the number of health care personnel were similar across the four months. Results The study population (N = 8,125) included the RETTS-p group (N = 4,129) and the WEST-P group (N = 3,996). 21% of patients in WEST-P and 30% in RETTS-p were high urgency (red or orange). The median time to physician was 4 min shorter for red urgency patients, and 18 min shorter for orange urgency patients (both p < 0.001) in WEST-P compared to RETTS-p, from 5 to 1 and 30 to 12 min respectively. The median length of stay for all patients was 23 min shorter with WEST-P compared to RETTS-p, 166 and 189 min respectively (p < 0.001). Conclusion Less overtriage can shorten time to physician for high urgency patients and reduce the length of stay for patients of all priorities at a PED.