MANCHESTER TRIAGE SYSTEM

Implementation of the Manchester Triage System in the Accident and Emergency Department at Sultan Qaboos University Hospital and its Impact on Practice



Table of Contents

Chapter 1: Introduction3

Background of the study3

Problem Statement3

Purpose of the study5

Rationale of the study5

Aims & Objectives of the study6

Significance of the study6

Chapter 2: Literature Review8

Chapter 3: Methodology11

Research Design11

Case Study 1: Modifying the Manchester Triage System in Practice :( Barron, 2002)11

Case Study 2 Detecting High Risk Patients with Chest Pain: Speake et al., (2003)12

Chapter 4: Results & Findings14

Case Study 114

Case study 215

Chapter 5: Conclusion18

References21

Appendices24

Chapter 1: Introduction

Background of the study

At present the A&E at SQUH does not follow a formal five level triage system as they have only three levels. When a client comes to the department seeking for treatment regardless their condition, their vital signs are checked and the nurse will categorize them in one of these three levels, Red (Severe head injuries traumatised patients and other life threatening), Orange Exp (Patients with abdominal pain, chest pain, uncontrolled hypertension and other conditions), and finally Yellow for all Patients with deferent complain. After clients have been categorised in one of these three levels, they will be asked to wait if Not Red/Orange in the waiting area based on nurses assessment in order to see the doctor.

Problem Statement

Nurses often participate in daily activities related to improving patient care despite not being publicly acknowledged. As a consequence, nurses faced a lot of challenges in dealing with some situations especially those who work with patient attending accidents and emergency (A&E). In fact, longer waiting time and crowding in A&E have been a critical healthcare issue in Sultan Qaboos University Hospital (SQUH/Oman). Moreover, this concern affects the financial status of the healthcare organization. Davis et al., (2007) identified a tremendous increase in the consumption of resources mainly for improper management in healthcare institutions.

The Omani healthcare system is facing a number of challenges as a result of over utilization of resources. Costs have escalated and the delivery of care is now generally poor due to improper patient categorization in A&E. Consequently, the hospital has created a three level triage system as a strategy to ease the pressure on nurses. Unfortunately, these three categories seem not appropriate. This is definitely a problem that needs special consideration and innovation.

The triage system in SQUH (Oman), lacks two important categories namely the green (sick but can wait) and blue (Sick but they can go to nearest primary health centre) and that create work load on nurses and affect other patient who required immediate assessment. According to Oktay et al. (1998), patient attending the A&E requires accurate assessment and need to be categorized according to his/her illness severity.

The majority of A&E patients who comes to SQUH are considered as non urgent cases and can be categorized as green / blue yet, in the absence of the green and blue level the triage nurse ends up labelling these patients as yellow (Sick and need to be seen by doctor within an hour) although their condition allows ...