Effect of computer-based decision support system on triage management in emergency department

Objective: Triage in emergency department overstrains employees due to patient density, diversity and time pressure. The objective of this study is to design a computer-based Decision Support System (DSS) using the ESI (Emergency Severity Index) and ATS (Australasian Triage Scale) algorithms, integrate it into the Hospital Information Management System (HIMS), evaluate the effect of the triage management in emergency department and ensure the continuity of the system. Method: This is a quasi-experimental study with a single-group pre-test and post-test design. The study consisted of three stages. In the first stage, a SQL (Structured Query Language) Script was developed to evaluate the accuracy and duration of pre- and post-DSS triage decisions. In the second stage (pre-test), the accuracy and duration of pre-DSS triage decisions were evaluated. In the second stage, a DSS was prepared with rule-based decision trees method using the ESI and ATS algorithms and was integrated into the HIMS. In the third and last stage (post-test), the effect of the developed Emergency Triage Decision Support System (ETDSS) on triage management was evaluated against the accuracy and duration of triage decisions. Findings: The developed system was found to be effective in the management of emergency nurse triage. The evaluations were made before the ETDSS (pre-test) with data of 7,765 real patients, and after the ETDSS (post-test) with data of 16,409 real patients. While the accuracy rate of triage decision in the pre-test was 57,8% (n = 9487), the accuracy rate increased to 64,9% (n=5038) in the post-test. The average duration of triage was 1.47±0.72 minutes in the pre-test, and as 1.79±0.85 minutes in the post-test. It was determined that the ETDSS increased the triage accuracy rates independently by eliminating experience, age and gender factors, affecting triage decisions. Conclusion: The ETDSS, which was developed and integrated into the HIMS, has increased the accuracy rates of triage decisions of nurses and brought the triage time closer to the time recommended in the literature. The system has positively affected the triage decisions of novice nurses and decreased inaccurate triage rates. The ETDSS supports patient safety and quality improvement processes. Since the system provides continuous data, the accuracy and duration of triage in emergency department can be used as a quality indicator in health. Keywords: emergency department, nurse triage, computer-based decision support systems, triage management