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An emergency department (ED) is a large and complex system (Smith & Craig Feied, 1999). The overall quality of an emergency department (ED) can be measured, among other factors, by its ability to supply fast and efficient, yet high-quality medical treatment for all patients. Patient care in the ED is a continuous stream of activities, beginning with initial contact and triage and ending with the patient leaving the ED for either an inpatient department or home. Long waiting times and overcrowding characterize most EDs nowadays and have a significant negative impact on patient safety, quality of care and satisfaction (Jiménez et al., 2003). Measuring the quality and efficiency of patient care in the ED at the national level in a standardized, detailed, and reproducible manner is extremely complex (Nwomeh, Lowell, Kable, Haley, & Ameh, 2006). The ability to manage this knowledge into a unified support system is a prerequisite for effective (Zeleny, 2013) Nevertheless, ED quality indicators have been developed in some countries, such as the USA, Australia, New Zealand, Britain, and Canada.
ED triage systems can play a key role in performance. For this reason, a number of countries have developed acuity scales to help optimize the efficiency and quality of ED patient care. For example, the Canadian ED triage and acuity scale (CTAS) (Bullard, Unger, Spence, & Grafstein, 2008) has five acuity levels consisting of resuscitation (patient needs to be seen by a physician immediately), emergent (patient needs to be seen by a physician within 15 minutes), urgent (needs to be seen within 30 minutes), less urgent (needs to be seen within 60 minutes) and non-urgent (needs to be seen within 120 minutes). This scale has been shown to accurately define the patients’ acuity level and to assist ED staff members in evaluating patients, resource needs, and performance against certain operating objectives (Elkum, Barrett, & Al-Omran, 2011). The CTAS feasibility and validity were also assessed outside of Canada (external validity), specifically in Andorra (Jiménez et al., 2003) and Saudi Arabia (Elkum et al., 2011). Using four relevant quality indicators: time to triage (should be ≤ 10 minutes), triage duration (should be ≤ 5 minutes), waiting time to nurse and physician, and proportion of patients leaving without being seen by a physician (should be ≤ 2%) its implementation was proven. In addition, its ability to predict admission rates, hospital length of stay and diagnostic utilization was shown (Jiménez et al., 2003).
The CTAS, although its ability to predict other parameters than the acuity measure was proven, is focusing mainly on the triage process. More indices are required for the overall assessment of the ED performance.