As students working on a healthcare technology project, we recognize the importance of understanding the medical frameworks that guide emergency care. While our focus is on developing a technological solution, it is essential that we align our system with real-world clinical practices. Recently, the doctors advising us recommended a key NHS document on emergency department triage and acuity measurement. This document serves as a foundation for our learning, offering insights into how patients are assessed and prioritized in emergency settings.
Given the complexity of emergency medicine, our goal is to ensure that our system integrates seamlessly with existing triage protocols. To achieve this, we have been studying the methodologies used in different healthcare systems, particularly the Manchester Triage System (MTS) - the standard applied in Portugal. By analyzing MTS and comparing it with other triage models, such as the Emergency Severity Index (ESI) and the Canadian Triage and Acuity Scale (CTAS), we can design a system that not only supports current practices but also introduces enhancements where possible.
The Role of Triage in Emergency Departments
“Triage is a vital component in the process of assessing and prioritizing patients and defined as “the process of sorting people in need of medical attention in order to determine priority.”(Peta et al., 2023)
An effective triage system must balance speed, accuracy, and resource allocation. It must enable healthcare providers to quickly assess a patient's condition, determine the urgency of care required, and assign an appropriate level of priority. To achieve this, triage systems rely on standardized criteria that guide decision-making and ensure consistency across different hospitals and regions.
The acuity measurement component of triage refers to how severe a patient's condition is, based on observable symptoms and clinical risk factors. Different triage scales classify patients into priority levels, ensuring that resources such as medical staff, equipment, and hospital beds are allocated effectively.
In the NHS, triage is structured and follows specific guidelines. The system aims to minimize wait times, optimize patient flow, and ensure that emergency care is delivered efficiently. Some hospitals also use digital triage tools, which help assess patients before they even arrive at the hospital, reducing congestion and allowing staff to prepare for incoming cases.
The Manchester Triage System (MTS) in Portugal
One of the most widely adopted triage models worldwide is the Manchester Triage System (MTS). Originally developed in the UK in 1996, MTS is used in Portugal and many other countries to standardize the triage process. Its structured approach ensures that patients are categorized based on the urgency of their medical needs.
How the Manchester Triage System (MTS) Works
The Manchester Triage System (MTS) categorizes patients into five color-coded groups, each indicating a different level of urgency for medical attention:
- Red - Immediate: Patients in life-threatening conditions require immediate intervention.
- Orange - Very Urgent: Patients must be assessed within 10 minutes due to severe but non-life-threatening conditions.
- Yellow - Urgent: Patients require medical attention within 60 minutes to prevent potential deterioration.
- Green - Standard: Patients should receive care within 120 minutes, as their condition is stable but requires attention.
- Blue - Non-Urgent: Patients can safely wait up to 240 minutes, as they have minor ailments that may not require emergency treatment.
Each classification is determined through a structured process involving clinical decision flowcharts and symptom-based evaluation. These standardized decision trees help healthcare professionals assess patient symptoms and assign the appropriate priority level, ensuring an effective and organized triage process.
Why We Prioritize Yellow Patients
As previously mentioned in our blog (Stakeholder Meeting), our primary focus is on yellow-category patients. These individuals represent a critical but often overlooked group - they require urgent medical attention, yet their conditions are not immediately life-threatening. The challenge lies in balancing timely care with resource allocation.
Yellow patients constitute a significant proportion of emergency department cases - in some instances, up to 42% of all admissions. Despite not being in immediate danger, delays in their treatment can lead to severe complications, including condition deterioration, prolonged hospital stays, or even escalation to a more critical state.
Addressing this issue is crucial to improving patient outcomes and optimizing emergency department efficiency.
Enhancing Triage Efficiency with Continuous Monitoring
By integrating real-time patient monitoring into the triage process, we aim to ensure that yellow-category patients receive timely and appropriate care. Our system utilizes wearable sensors, data processing algorithms, and real-time alerts to:
- Continuously track vital signs such as heart rate, oxygen levels, and movement patterns.
- Detect early signs of deterioration, preventing escalation to more critical conditions.
- Alert medical staff when intervention is needed, reducing unnecessary delays.
- Optimize triage decisions, ensuring high-priority cases are addressed efficiently.
Through this approach, we aim to bridge the gap between technology and emergency care, enhancing the Manchester Triage System with data-driven insights and improved patient monitoring. By prioritizing yellow-category patients, we can significantly improve response times, resource allocation, and overall patient outcomes in emergency settings.
Benefit of MTS
MTS has several advantages that make it effective in emergency departments:
- Standardization: Ensures that all patients are assessed using the same clinical criteria, reducing variability between different hospitals.
- Efficiency: Allows rapid decision-making, helping hospitals manage large numbers of patients effectively.
- Resource Optimization : Helps prioritize patients based on urgency, ensuring that critical cases receive immediate attention.
Limitations and Challenges of MTS
Despite its advantages, MTS is not perfect. Some of its challenges include:
- Subjectivity: Ensures that all patients are assessed using the same clinical criteria, reducing variability between different hospitals.
- Overcrowding in Emergency Departments: MTS does not directly address hospital overcrowding, which remains a major issue in emergency care.
- Need for Digital Integration : Many hospitals still rely on manual triage processes, leading to delays in patient assessment.
Given these limitations, new approaches - including automated triage tools, AI-assisted decision-making, and wearable health monitoring systems - are being explored to enhance emergency care.
Comparing MTS with Other Triage Systems
To improve the effectiveness of our system, we have been researching other triage models used internationally. Two of the most prominent systems are the Emergency Severity Index (ESI) used in the United States and the Canadian Triage and Acuity Scale (CTAS) used in Canada.
Emergency Severity Index (ESI)
The ESI is a five-level triage system similar to MTS but with a stronger focus on resource utilization. Instead of only considering the urgency of the patient’s condition, ESI also evaluates how many hospital resources will be required to treat the patient.
- ESI Level 1: Immediate life-saving intervention required.
- ESI Level 2: High-risk patient, needs immediate care.
- ESI Level 3: Multiple resources required but stable condition.
- ESI Level 4: One resource required.
- ESI Level 5: No resources needed, minimal care required.
Canadian Triage and Acuity Scale (CTAS)
CTAS, like MTS, uses five levels to classify patient urgency, but it incorporates more detailed clinical criteria. The system relies on symptom-based guidelines and specific patient presentations to determine priority.
How This Knowledge Helps Improve Our System
Studying these systems allows us to design a more robust and adaptable solution. Some key takeaways for our project include:
- Combining Clinical Urgency with Resource Consideration: MTS focuses on urgency, while ESI considers both urgency and resource use. A hybrid approach could improve hospital efficiency.
- Digitalizing Triage: Many hospitals still rely on manual triage processes. Integrating wearable monitoring devices could help automate data collection and speed up decision-making.
- Improving Triage for Moderate-Risk Patients: Many patients fall into yellow and green categories, leading to long wait times. An advanced triage system could provide continuous monitoring to detect deterioration in these patients.
Conclusion: Towards a Smarter Triage System
As we develop our healthcare technology solution, our goal is to enhance the existing triage process rather than replace it. Understanding MTS and other triage models allows us to align our system with clinical practices while introducing improvements through wearable technology, automated data processing, and real-time monitoring.
By integrating lessons from multiple triage systems, we hope to create a more efficient, accurate, and responsive emergency monitoring system. This knowledge will guide our engineering decisions, ensuring that our technology meets the real-world needs of emergency healthcare professionals.