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

## TL;DR

Replacing a pediatric triage system reduced overtriage and improved patient flow in a hospital emergency department.

## Contribution

This study is the first to compare the impact of different pediatric triage systems on patient flow and overtriage.

## Key findings

- The WEST-P triage system reduced overtriage compared to RETTS-p.
- WEST-P decreased the median time to physician for high urgency patients by 4-18 minutes.
- Overall patient length of stay was 23 minutes shorter with the WEST-P system.

## Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s13049-026-01573-w.