# Compliance With Triage Protocols in the Emergency Department: A Retrospective Audit

## TL;DR

This study evaluated how well emergency department staff followed triage protocols and found that about 24% of patients were triaged incorrectly, with errors more common during busy times and for certain patient categories.

## Contribution

The study provides a detailed audit of triage protocol compliance in a tertiary care ED, identifying factors like triage category and time of presentation that influence accuracy.

## Key findings

- Overall compliance with triage protocols was 75.6%, with 24.4% of cases non-compliant.
- Under-triage occurred in 15.6% of cases, more frequently than over-triage (8.9%).
- Compliance was significantly lower during peak hours and for Category III patients.

## Abstract

Background

Triage is a critical component of emergency department (ED) operations, ensuring that patients are prioritized according to the severity of their condition.

Objective

This study aims to evaluate compliance with standardized triage protocols in a tertiary care ED and to determine the frequency of under-triage and over-triage in relation to patient characteristics and time of presentation.

Materials and methods

This retrospective observational study was conducted at Shalamar Hospital, Lahore, Pakistan, from March 2022 to March 2025. Medical records of 135 patients presenting to the ED during the study period were reviewed. Data collected included demographics, presenting complaints, assigned triage categories, and compliance with institutional triage guidelines. Compliance was defined as adherence to standardized triage criteria, while deviations were categorized as under-triage or over-triage. Associations between compliance and patient characteristics were assessed using Pearson’s chi-square test, with p < 0.05 considered statistically significant.

Results

The mean age of patients was 42.6 ± 18.3 years, with 83 (61.5%) males and 52 (38.5%) females. Medical presentations were most frequent (62.2%), followed by surgical (23.7%) and trauma-related (14.1%) cases. Overall compliance with triage protocols was 75.6% (102/135 cases), while 24.4% (33/135 cases) were non-compliant. Among non-compliant cases, 21 (15.6%) were under-triaged and 12 (8.9%) over-triaged. Compliance was highest among Category I patients (86.4%) and lowest among Category III patients (69.2%). Significant associations were observed between compliance and both triage category (χ² = 5.56, p = 0.04) and time of presentation (χ² = 4.71, p = 0.03), with lower compliance during peak hours.

Conclusions

Compliance with triage protocols in the ED was moderately high but suboptimal, with nearly one-fourth of patients triaged incorrectly. Under-triage was more common, representing a significant safety concern. Compliance was significantly influenced by triage category and time of presentation, highlighting the need for staff training, system support, and workload management to improve triage accuracy.