Knowledge and Practices of triage among Emergency department nurses at Kanti Children’s Hospital

Knowledge and Practices of triage among Emergency department nurses at Kanti Children’s Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge and Practices of triage among Emergency department nurses at Kanti Children’s Hospital Anupama K Yadav, Bulu Wagle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7164060/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Triage plays a critical role in optimizing emergency care delivery, especially in resource-limited settings like Nepal. However, inadequate training and inconsistencies in triage knowledge among nurses may compromise patient outcomes. Kanti Children’s Hospital, the only government-run pediatric tertiary care center in Kathmandu, handles high patient volumes but operates partial triage services (1 PM to 7 PM) due to limited staffing. Objective: To assess the knowledge, practice, and confidence of emergency nurses regarding triage and to determine associations between training, knowledge accuracy, and practices. Methods: Informed verbal consent was taken and a descriptive cross-sectional study was conducted among 27 female nurses out of 29 working in the emergency department at Kanti Children’s Hospital who consented were included in this study from May 5 to May 12, 2025. A structured questionnaire consisting of 20 multiple-choice questions was used to evaluate participants demographic profiles, triage knowledge, perceived practices. Data were analyzed using SPSS version 27, and chi-square tests were applied to assess associations. A p-value of < 0.05 was considered statistically significant. Results: Only 40.7% of participants had received formal triage training. The majority (74.1%) were aged 20–30 years, and 63% had less than one year of emergency experience. Although 62.9% reported feeling very confident in triaging patients, only 40.7% correctly answered triage-related knowledge questions.There was a significant association p value < 0.05 between formal training and triage knowledge accuracy. However, no statistically significant association was found between confidence levels and knowledge scores indicating that self-reported confidence does not reliably predict competence. Conclusion: The study revealed notable gaps in triage knowledge among emergency nurses, despite high self-reported confidence. Formal training was significantly associated with better triage knowledge, emphasizing the urgent need for structured training programs, 24-hour triage implementation, and regular competency assessments, and conduction of triage training before emergency posting. Bridging the gap between confidence and actual knowledge is essential for improving emergency care quality and patient outcomes in pediatric settings. Introduction Triage is crucial and important in resource limited settings particularly in busy hospitals where the demand for emergency care often exceeds available resources. Triage is considered sorting mechanism of patients in hospital-based emergency departments. Triage refers to assessment and classification of patients visiting emergency department to prioritize their health problems from life-threatening to low risk to receive appropriate treatment as per requirements ( 1 ), ( 2 ). At Kanti Children’s Hospital, 25 beds are allocated for emergency, the only national tertiary-level government pediatric hospital in Nepal, the emergency department handles a substantial patient load, last year as per official website of hospital, 42262 children in a year visited emergency department. However, due to inadequate staffing and infrastructure, partial triage services are only operational between 1:00 PM to 7:00 PM in evening. Outside these hours, emergency care is often administered without standardized triage protocols, increasing the risk of delayed treatment and potential clinical deterioration in critically ill children ( 3 ). If there is lack of triage system or lack of knowledge of triage it can lead to devastating complications or higher mortality which could have been prevented otherwise ( 4 ), ( 5 ). The quality of services provided in emergency department has its consequences not only on patients survival but also on their hospital experience, care satisfaction, and psychological well-being ( 6 ), ( 7 ). Materials & Methods Ethical approval was obtained from the Institutional Review Board (IRB) of Kanti Children's Hospital, Kathmandu, (Approval number: 894). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with comparable ethical standards. Verbal informed consent was obtained from all individual participants included in the study. After receiving ethical clearance from the Institutional Review Board of Kanti Children’s Hospital, a descriptive cross-sectional study was conducted among nurses working in the emergency department. The study aimed to assess their knowledge, practices regarding triage. Among 29 nursing staff working in emergency department, 27 were included who consented for this study. A structured, self-administered questionnaire consisting of 20 multiple-choice questions was adopted based on previous studies outside Nepal was used ( 8 ). The questionnaire was divided into four sections: {1} demographic details, {2} knowledge of triage and {3} triage practices ( 9 ). Participants completed the questionnaires during their shift breaks. The data were coded and entered into IBM SPSS Statistics Version 27. Descriptive statistics including, percentages, and p value were used to summarize the responses. Findings were presented using tables for clarity. Results Among 27 emergency department nursing staff, all were female. Regarding qualifications: 48.1% held a PCL degree, 40.7% had a BSc in Nursing, and 11.1% had other qualifications including a master’s degree. As for experience, 63% had less than 1 year of experience and 22.2% had 1-5 years of experience and 14.8% had more than 5 years of experience. On answer to question of main purpose of triage in emergency department, 92.6% correctly answered as patients are treated based on urgency and 7.4% answered to reduce overcrowding. None of them choose other options such as treatment to those who arrive first and to improve hospital efficiency. Regarding use of triage system, only 63% of participants knew World Health Organization(WHO) system is used. 33.3% answered as Australasian Triage Scale (ATS) and 3.7% answered as Manchester Triage System. Regarding formal triage training, only 40.7% had received such training and 92.6% answered correctly that triage aimed to provide treatment based on urgency. 77.8% correctly identified “Red” as the highest priority category. Condition Number Percent % Fever 2 7.4 Chest pain and difficulty breathing 21 77.8 Broken arm 2 7.4 1 and 2 2 7.4 Table 1: Table showing result based on first priority for treatment Table 1 describes about the answer to question which condition should be prioritized. 77.8% answered correctly as chest pain and difficulty breathing. 6 participants choose as fever, broken arm and fever with chest pain difficulty breathing. Action Number Percent % Treat both 3 11.1 Help 11 40.7 Survival basis 9 33.3 Arrival basis 2 7.4 2 and 3 2 7.4 Table 2: Table showing answers to question if two critically ill patients arrive at same time As stated in Table 2 only 40.7% answered correctly as ask for help in case if two sick case arrives simultaneously. Reassessment Time Number Percent % 15 minutes 11 40.8 30 minutes 6 22.2 60 minutes 2 7.4 If condition changes 8 29.6 Table 3: Table showing answer to reassessment in waiting area Only 40.7% knew that every 15 minutes reassessment of patients should be done, Table 3. Response Percent (%)(Number) Assess, Prioritize, Document, Refer 77.5 (21) Assess, Treat, Discharge, Document 7.5 (2) Document, Refer, Assess, Prioritize 7.5 (2) Treat, Document, Assess, Discharge 7.5 (2) Table 4: This table shows answer to question of correct triage process 77.8% correctly identified the sequence: Assess → Prioritize → Document → Refer; Table 4. Frequency Percent (%)(Number) Always 55.5 (15) Sometimes 29.6 (8) Often 11.1 (3) Rarely 3.7 (1) Table 5: This table shows how frequently emergency nurses perform triage duties Table 5 shows answer to question how frequently did they do triage, 55.5% answered as always. Confidence Level Percent (%)(Number) Very confident 63 (17) Somewhat confident 25.9 (7) Neutral 7.4 (2) Not confident 3.7 (1) Table 6: This table shows answer to question whether they feel confident to triage patients correctly 62.9% answered that they were very confident in performing triage; Table 6. Challenge Percent (%)(Number) Overcrowding 81.4 (22) Lack of formal training 62.9 (17) Limited staff 44.4 (12) Inconsistent guidelines 25.9 (7) Table 7: This table shows answer to question as biggest challenges when performing triage Table 7 states answers to challenges faced during triage, the answers were overlapped since more than one answer was choosen by staffs: 22 answered as Overcrowding ,17 choose Lack of formal training ,12 answered as Limited staff ,Inconsistent guidelines were chosen by 7. Waiting Time Percent (%)(Number) <15 minutes 66.9 (18) 15–30 minutes 33.3 (9) Table 8: This chart shows answer to question waiting time for patients before receiving treatments Table 8 states answer to question how is the queue, 66.9% answered as less than 15 minutes, which shows waiting time is not very long. Method Percent (%)(Number) Attending workshops 29.6 (8) Reading medical literature 62.9 (17) Consulting colleagues/mentors 70.3 (19) Table 9: This table shows ways to update knowledge Table 9 shows answer to question how does the staff improve their knowledge, the answers choosen were: · Attending workshops and training sessions – 8, Reading medical literature – 17, Consulting colleagues and mentors – 19 Suggestion Percent (%)(Number) More training programs 100 (27) Clearer guidelines 66.9 (18) Increase staff 44.4 (12) Computerized triage systems 40.7 (11) Table 10: This chart shows answer to ways to improve triage efficiency in this hospital Suggestions for Improvement of triage Table 10: 27 staff recommended more triage training programs., 18 supported the need for clearer triage guidelines., 12 suggested to increase number of staff., 11 supported implementing computerized triage systems. Confidence Level Correct Incorrect p value Very Confident 2 15 < .001 Somewhat Confident 9 1 Table 11: Table shows relation between confidence and correct answer Although the confidence level was high its association with correct answer was inversly proportional making it statically significant, Table 11. Training Correct Incorrect p value Yes 11 0 < .001 No 0 16 Table 12: Table showing relation between training and correct answer Those who received formal triage training got more answers correct making it statically significant, Table 12. Our study showed formal traige training is key to improve knowledge and confidence level should not be associated with knowledge. Discussion At Kanti Children’s Hospital, there is still a lack of 24-hour triage services due to insufficient human resources, which is vital for the emergency department. As the only tertiary government children's hospital in Kathmandu receiving patients nationwide, the need for an effective triage system is critical. High levels of triage knowledge and practice can reduce overcrowding, shorten waiting times, improve patient flow, and increase practices ( 10 ). The outcome of treatment depends heavily on quick and accurate triage. Studies demonstrate that appropriate triage decreases mortality and enhances resource utilization ( 9 ). Accurate triage supports the processes of admission, stabilization, and treatment ( 11 ). Conversely, lack of triage system knowledge results in wasted resources, delayed admissions, patient dissatisfaction, and adverse outcomes. An accurate triage system can determine treatment trends and facilitate effective patient management ( 12 ), ( 13 ). This study revealed that only around two-thirds of emergency triage nurses (Table 1 , 2 , 4 ) demonstrated up-to-date knowledge, indicating a significant gap ( 11 ). All nurses agreed that a standardized triage protocol was followed. Over 60% felt confident performing triage, though overcrowding (Table 7 ) was the biggest challenge, likely due to public awareness gaps, lack of formal training, understaffing, and inconsistent guidelines,(Table 10) reflecting both systemic issues and patient trust ( 14 ). Nurses updated their knowledge mainly by consulting colleagues and mentors, reading medical literature, and attending workshops. Correct triage is linked with better health outcomes, as timely assessment facilitates early doctor evaluation. However, over-triage and under-triage-assigning a patient to a higher or lower acuity category than necessary-can negatively impact care ( 15 ). To improve triage efficiency, respondents suggested more training programs, clearer guidelines, increased staffing, and computerized triage systems, Table 10. Standardization is expected to enhance triage quality, classification accuracy, and overall emergency care; and confidence of staff doesn’t necessarily shows knowledge of triage ( 15 ), ( 16 ). Since early assessment improves patient outcome recurring triage training should be conducted as our study showed 63% of nursing staff had < 1 year of experience signifying increase turn over of staffs. This study showed association between training and increase knowledge ,Table 12 similar with other studies; emphasizing need for triage training before emergency department posting ( 15 ). Since the study population is small further extensive multicentric studies are required to validate the questionnaire showing limitation of study. Conclusions This study highlights critical gaps in triage knowledge and practice among emergency department nurses at Kanti Children’s Hospital, the only government-run tertiary pediatric center in Kathmandu. Despite all participants expressing high levels of self-reported confidence in performing triage, only a portion demonstrated accurate understanding of key triage principles and protocols. Given the hospital’s high patient inflow and the limited hours during which triage services are available (1 PM to 7 PM), there is a pressing need to: Expand triage services to a 24-hour model ,develop and implement structured triage training programs, reinforce the use of standardized triage protocols, address system-level issues like overcrowding and staff shortages. Improving triage knowledge through structured training and regular evaluation will not only enhance clinical decision-making and reduce waiting times but also contribute significantly to patient safety, satisfaction, and overall quality of emergency care. Institutional commitment to capacity building and triage system reform is essential for sustainable improvement in pediatric emergency care delivery. Declarations Ethical Approval letter from Institutional review board of Kanti Children’s Hospital, Nepal Funding: None Clinical trial number: Not applicable Author Contribution Author has made contribution in revising and given suggestion in finalizing the research. References Emergency department crowding, Morley C, Unwin M, Peterson G, Stankovich J, Kinsman L. A systematic review of causes, consequences, and solutions. s l : PLoS One. 2018;13:0203316. 10.1371/journal.pone.0203316 . The Performance of Emergency Department Nurses Across Sectors in Jordan: An Application of the Work Functioning Model. Res Theory Nurs Pract, Al-Kalaldeh M. Samah Khamis. 344–356, 2019, Vol. 33. 10.1891/1541-6577.33.4.344 Website. Kanti Children's Hospital. 2025. http://01-4511550/4513398. Knowledge of Triage among Nurses in Emergency Units, Ali S, Taverner BCB, Ghani M, Kussor Z, Naz S. 240–242, s.l.: Biomedica, 2013, Vol. 29. Organization. World Health. Emergency Triage Assessment and Treatment. 2005. Triage Knowledge and Practice and Associated Factors Among Emergency Department Nurses, AlShatarat M, Rayan A, Eshah NF, Baqeas MJ, Jaber MJ, ALBashtawy M. s.l.: SAGE Open Nurs, 2022. 8:23779608221130588. 10.1177/23779608221130588 Knowledge on triage management among nurses in a tertiary level hospital of Kathmandu, Bista S, Mukhia S, Rai L. 1–6, s.l. Res Gate, 2022, 4. Knowledge and Practices of Triage Amongst Nurses Working in the Emergency Departments of Rural Hospitals in Limpopo Province, Phukubye TA, Mbombi MO, Mothiba TM. 439–445, s.l.: The Open Public Health Journal, 2019, Vol. 12. 10.2174/1874944501912010439 Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study, Duko B, Geja E, Oltaye Z et al. 21, s.l.: BMC Res Notes, 2019, Vol. 12. 10.1186/s13104-019-4062-1 Triage. knowledge, perceived skills, and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: multicenter cross-section. Bahre W, Bahre, Willi, Mengist, Bete,Bitsa, Yihdego. 7029–7035, s.l.: Ann Med Surg, 2024, Vol. 86. 86:7029–7035. 10.1097/MS9.0000000000002703 The effect of triage training on the performance of triage nurses and emergency medical staff of Iranshahr, Ebrahimi M, Ghanbarzehi N, Ghanbarzahi Gorgich Z, Darban F, Shirzadi F. 190–196, s.l.: Int J Med Res Health Sci, 2016, Vol. 5. Reliability and validity of a new five-level triage instrument, Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. 262–267, s.l.: Acad Emerg Med, 2000, Vol. 7. 10.1111/j.1553-2712.2000.tb01066.x Australian triage nurses’ decision making and scope of practice, Gerdtz M, Bucknall T. s l : Australas J Adv Nurs. 2000;18:24–33. Emergency department provider in triage: assessing site-specific rationale, operational feasibility, and financial impact, Franklin BJ, Li KY, Somand DM et al. 12450, s.l.: J Am Coll Emerg Physicians Open, 2021, Vol. 2. 10.1002/emp2.12450 Evaluating Healthcare Teams' Knowledge about Hospital Triage: A Review of Studies Conducted. NZ, Jelyani. 1–9, s.l.: Int J Psychosoc Rehabil., 2020, Vol. 24. 10.37200/IJPR/V2418/PR280302 Reliability of triage, Magalhães-Barbosa MC, Robaina JR, Prata-Barbosa A, Lopes CS. systems for paediatric emergency care: a systematic review. Volume 10. BMJ; 2018. 1136, s.l. Additional Declarations No competing interests reported. Supplementary Files Appendices.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Triage is considered sorting mechanism of patients in hospital-based emergency departments. Triage refers to assessment and classification of patients visiting emergency department to prioritize their health problems from life-threatening to low risk to receive appropriate treatment as per requirements (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt Kanti Children\u0026rsquo;s Hospital, 25 beds are allocated for emergency, the only national tertiary-level government pediatric hospital in Nepal, the emergency department handles a substantial patient load, last year as per official website of hospital, 42262 children in a year visited emergency department. However, due to inadequate staffing and infrastructure, partial triage services are only operational between 1:00 PM to 7:00 PM in evening. Outside these hours, emergency care is often administered without standardized triage protocols, increasing the risk of delayed treatment and potential clinical deterioration in critically ill children (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIf there is lack of triage system or lack of knowledge of triage it can lead to devastating complications or higher mortality which could have been prevented otherwise (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The quality of services provided in emergency department has its consequences not only on patients survival but also on their hospital experience, care satisfaction, and psychological well-being (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from the Institutional Review Board (IRB) of Kanti Children's Hospital, Kathmandu, (Approval number: 894). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with comparable ethical standards. Verbal informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eAfter receiving ethical clearance from the Institutional Review Board of Kanti Children\u0026rsquo;s Hospital, a descriptive cross-sectional study was conducted among nurses working in the emergency department. The study aimed to assess their knowledge, practices regarding triage. Among 29 nursing staff working in emergency department, 27 were included who consented for this study.\u003c/p\u003e\u003cp\u003eA structured, self-administered questionnaire consisting of 20 multiple-choice questions was adopted based on previous studies outside Nepal was used (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The questionnaire was divided into four sections: {1} demographic details, {2} knowledge of triage and {3} triage practices (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants completed the questionnaires during their shift breaks.\u003c/p\u003e\u003cp\u003eThe data were coded and entered into IBM SPSS Statistics Version 27. Descriptive statistics including, percentages, and p value were used to summarize the responses. Findings were presented using tables for clarity.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 27 emergency department nursing staff, all were female. Regarding qualifications: 48.1% held a PCL degree, 40.7% had a BSc in Nursing, and 11.1% had other qualifications including a master\u0026rsquo;s degree. As for experience, 63% had less than 1 year of experience and 22.2% had 1-5 years of experience and 14.8% had more than 5 years of experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn answer to question of main purpose of triage in emergency department, 92.6% correctly answered as patients are treated based on urgency and 7.4% answered to reduce overcrowding. None of them choose other options such as treatment to those who arrive first and to improve hospital efficiency.\u003c/p\u003e\n\u003cp\u003eRegarding use of triage system, only 63% of participants knew World Health Organization(WHO) system is used. 33.3% answered as Australasian Triage Scale (ATS) and 3.7% answered as Manchester Triage System.\u003c/p\u003e\n\u003cp\u003eRegarding formal triage training, only 40.7% had received such training and 92.6% answered correctly that triage aimed to provide treatment based on urgency. 77.8% correctly identified \u0026ldquo;Red\u0026rdquo; as the highest priority category.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCondition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChest pain and difficulty breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBroken arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1 and 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;1: Table showing result based on first priority for treatment\u003c/p\u003e\n\u003cp\u003eTable 1 describes about the answer to question which condition should be prioritized. 77.8% answered correctly as chest pain and difficulty breathing. 6 participants choose as fever, broken arm and fever with chest pain difficulty breathing.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTreat both\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHelp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSurvival basis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eArrival basis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2 and 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;2: Table showing answers to question if two critically ill patients arrive at same time\u003c/p\u003e\n\u003cp\u003eAs stated in Table 2 only 40.7% answered correctly as ask for help in case if two sick case arrives simultaneously.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eReassessment Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e15 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e60 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIf condition changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;3: Table showing answer to reassessment in waiting area\u003c/p\u003e\n\u003cp\u003eOnly 40.7% knew that every 15 minutes reassessment of patients should be done, Table 3.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eResponse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAssess, Prioritize, Document, Refer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.5 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAssess, Treat, Discharge, Document\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDocument, Refer, Assess, Prioritize\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTreat, Document, Assess, Discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;4: This table shows answer to question of correct triage process\u003c/p\u003e\n\u003cp\u003e77.8% correctly identified the sequence: Assess \u0026rarr; Prioritize \u0026rarr; Document \u0026rarr; Refer; Table 4.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.5 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.6 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;5: This table shows how frequently emergency nurses perform triage duties\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 5 shows answer to question how frequently did they do triage, 55.5% answered as always.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eConfidence Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVery confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSomewhat confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.9 (7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.4 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNot confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;6: This table shows answer to question whether they feel confident to triage patients correctly\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;62.9% answered that they were very confident in performing triage; Table 6.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChallenge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOvercrowding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.4 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLack of formal training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.9 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLimited staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.4 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInconsistent guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.9 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;7: This table shows answer to question as biggest challenges when performing triage\u003c/p\u003e\n\u003cp\u003eTable 7 states answers to challenges faced during triage, the answers were overlapped since more than one answer was choosen by staffs:\u003c/p\u003e\n\u003cp\u003e22 answered as Overcrowding\u0026nbsp;,17 choose Lack of formal training\u0026nbsp;,12 answered as Limited staff\u0026nbsp;,Inconsistent guidelines were chosen by 7.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWaiting Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;15 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.9 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u0026ndash;30 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.3 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;8: This chart shows answer to question waiting time for patients before receiving treatments\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 8 states answer to question how is the queue, 66.9% answered as less than 15 minutes, which shows waiting time is not very long.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAttending workshops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.6 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eReading medical literature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.9 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eConsulting colleagues/mentors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.3 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;9: This table shows ways to update knowledge\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 9 shows answer to question how does the staff \u0026nbsp;improve their knowledge, the answers choosen were:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Attending workshops and training sessions \u0026ndash; 8, Reading medical literature \u0026ndash; 17, Consulting colleagues and mentors \u0026ndash; 19\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSuggestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePercent (%)(Number)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMore training programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eClearer guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.9 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIncrease staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.4 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eComputerized triage systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.7 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;10: This chart shows answer to ways to improve triage efficiency in this hospital\u003c/p\u003e\n\u003cp\u003eSuggestions for Improvement of triage Table 10:\u003c/p\u003e\n\u003cp\u003e27 staff recommended more triage training programs., 18 supported the need for clearer triage guidelines., 12 suggested to increase number of staff., 11 supported implementing computerized triage systems.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eConfidence Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCorrect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncorrect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVery Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSomewhat Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;11: Table shows relation between confidence and correct answer\u003c/p\u003e\n\u003cp\u003eAlthough the confidence level was high its association with correct answer was inversly proportional making it statically significant, Table 11.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTraining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCorrect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncorrect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;12: Table showing relation between training and correct answer\u003c/p\u003e\n\u003cp\u003eThose who received formal triage training got more answers correct making it statically significant, Table 12.\u003c/p\u003e\n\u003cp\u003eOur study showed formal traige training is key to improve knowledge and confidence level should not be associated with knowledge.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt Kanti Children\u0026rsquo;s Hospital, there is still a lack of 24-hour triage services due to insufficient human resources, which is vital for the emergency department. As the only tertiary government children's hospital in Kathmandu receiving patients nationwide, the need for an effective triage system is critical. High levels of triage knowledge and practice can reduce overcrowding, shorten waiting times, improve patient flow, and increase practices (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe outcome of treatment depends heavily on quick and accurate triage. Studies demonstrate that appropriate triage decreases mortality and enhances resource utilization (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Accurate triage supports the processes of admission, stabilization, and treatment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConversely, lack of triage system knowledge results in wasted resources, delayed admissions, patient dissatisfaction, and adverse outcomes. An accurate triage system can determine treatment trends and facilitate effective patient management (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study revealed that only around two-thirds of emergency triage nurses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e) demonstrated up-to-date knowledge, indicating a significant gap (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). All nurses agreed that a standardized triage protocol was followed. Over 60% felt confident performing triage, though overcrowding (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e7\u003c/span\u003e) was the biggest challenge, likely due to public awareness gaps, lack of formal training, understaffing, and inconsistent guidelines,(Table\u0026nbsp;10) reflecting both systemic issues and patient trust (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNurses updated their knowledge mainly by consulting colleagues and mentors, reading medical literature, and attending workshops. Correct triage is linked with better health outcomes, as timely assessment facilitates early doctor evaluation. However, over-triage and under-triage-assigning a patient to a higher or lower acuity category than necessary-can negatively impact care (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e To improve triage efficiency, respondents suggested more training programs, clearer guidelines, increased staffing, and computerized triage systems, Table\u0026nbsp;10. Standardization is expected to enhance triage quality, classification accuracy, and overall emergency care; and confidence of staff doesn\u0026rsquo;t necessarily shows knowledge of triage (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince early assessment improves patient outcome recurring triage training should be conducted as our study showed 63% of nursing staff had\u0026thinsp;\u0026lt;\u0026thinsp;1 year of experience signifying increase turn over of staffs. This study showed association between training and increase knowledge ,Table\u0026nbsp;\u003cspan refid=\"Tab12\" class=\"InternalRef\"\u003e12\u003c/span\u003e similar with other studies; emphasizing need for triage training before emergency department posting (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince the study population is small further extensive multicentric studies are required to validate the questionnaire showing limitation of study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights critical gaps in triage knowledge and practice among emergency department nurses at Kanti Children\u0026rsquo;s Hospital, the only government-run tertiary pediatric center in Kathmandu. Despite all participants expressing high levels of self-reported confidence in performing triage, only a portion demonstrated accurate understanding of key triage principles and protocols.\u003c/p\u003e\u003cp\u003eGiven the hospital\u0026rsquo;s high patient inflow and the limited hours during which triage services are available (1 PM to 7 PM), there is a pressing need to: Expand triage services to a 24-hour model ,develop and implement structured triage training programs, reinforce the use of standardized triage protocols, address system-level issues like overcrowding and staff shortages.\u003c/p\u003e\u003cp\u003eImproving triage knowledge through structured training and regular evaluation will not only enhance clinical decision-making and reduce waiting times but also contribute significantly to patient safety, satisfaction, and overall quality of emergency care. Institutional commitment to capacity building and triage system reform is essential for sustainable improvement in pediatric emergency care delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical Approval\u003c/h2\u003e\u003cp\u003e\u003cb\u003e letter from Institutional review board of Kanti Children\u0026rsquo;s Hospital, Nepal\u003c/b\u003e\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003cp\u003eClinical trial number: Not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor has made contribution in revising and given suggestion in finalizing the research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEmergency department crowding, Morley C, Unwin M, Peterson G, Stankovich J, Kinsman L. 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Kanti Children's Hospital. 2025. http://01-4511550/4513398.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKnowledge of Triage among Nurses in Emergency Units, Ali S, Taverner BCB, Ghani M, Kussor Z, Naz S. 240\u0026ndash;242, s.l.: Biomedica, 2013, Vol. 29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization. World Health. Emergency Triage Assessment and Treatment. 2005.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTriage Knowledge and Practice and Associated Factors Among Emergency Department Nurses, AlShatarat M, Rayan A, Eshah NF, Baqeas MJ, Jaber MJ, ALBashtawy M. s.l.: SAGE Open Nurs, 2022. 8:23779608221130588. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/23779608221130588\u003c/span\u003e\u003cspan address=\"10.1177/23779608221130588\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKnowledge on triage management among nurses in a tertiary level hospital of Kathmandu, Bista S, Mukhia S, Rai L. 1\u0026ndash;6, s.l. Res Gate, 2022, 4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKnowledge and Practices of Triage Amongst Nurses Working in the Emergency Departments of Rural Hospitals in Limpopo Province, Phukubye TA, Mbombi MO, Mothiba TM. 439\u0026ndash;445, s.l.: The Open Public Health Journal, 2019, Vol. 12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/1874944501912010439\u003c/span\u003e\u003cspan address=\"10.2174/1874944501912010439\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTriage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study, Duko B, Geja E, Oltaye Z et al. 21, s.l.: BMC Res Notes, 2019, Vol. 12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13104-019-4062-1\u003c/span\u003e\u003cspan address=\"10.1186/s13104-019-4062-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTriage. knowledge, perceived skills, and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: multicenter cross-section. Bahre W, Bahre, Willi, Mengist, Bete,Bitsa, Yihdego. 7029\u0026ndash;7035, s.l.: Ann Med Surg, 2024, Vol. 86. 86:7029\u0026ndash;7035. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MS9.0000000000002703\u003c/span\u003e\u003cspan address=\"10.1097/MS9.0000000000002703\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe effect of triage training on the performance of triage nurses and emergency medical staff of Iranshahr, Ebrahimi M, Ghanbarzehi N, Ghanbarzahi Gorgich Z, Darban F, Shirzadi F. 190\u0026ndash;196, s.l.: Int J Med Res Health Sci, 2016, Vol. 5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReliability and validity of a new five-level triage instrument, Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. 262\u0026ndash;267, s.l.: Acad Emerg Med, 2000, Vol. 7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1553-2712.2000.tb01066.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1553-2712.2000.tb01066.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustralian triage nurses\u0026rsquo; decision making and scope of practice, Gerdtz M, Bucknall T. s l : Australas J Adv Nurs. 2000;18:24\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEmergency department provider in triage: assessing site-specific rationale, operational feasibility, and financial impact, Franklin BJ, Li KY, Somand DM et al. 12450, s.l.: J Am Coll Emerg Physicians Open, 2021, Vol. 2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/emp2.12450\u003c/span\u003e\u003cspan address=\"10.1002/emp2.12450\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEvaluating Healthcare Teams' Knowledge about Hospital Triage: A Review of Studies Conducted. NZ, Jelyani. 1\u0026ndash;9, s.l.: Int J Psychosoc Rehabil., 2020, Vol. 24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.37200/IJPR/V2418/PR280302\u003c/span\u003e\u003cspan address=\"10.37200/IJPR/V2418/PR280302\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReliability of triage, Magalh\u0026atilde;es-Barbosa MC, Robaina JR, Prata-Barbosa A, Lopes CS. systems for paediatric emergency care: a systematic review. Volume 10. BMJ; 2018. 1136, s.l.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7164060/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7164060/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction:\u003c/p\u003e\u003cp\u003eTriage plays a critical role in optimizing emergency care delivery, especially in resource-limited settings like Nepal. However, inadequate training and inconsistencies in triage knowledge among nurses may compromise patient outcomes. Kanti Children\u0026rsquo;s Hospital, the only government-run pediatric tertiary care center in Kathmandu, handles high patient volumes but operates partial triage services (1 PM to 7 PM) due to limited staffing.\u003c/p\u003e\u003cp\u003eObjective:\u003c/p\u003e\u003cp\u003eTo assess the knowledge, practice, and confidence of emergency nurses regarding triage and to determine associations between training, knowledge accuracy, and practices.\u003c/p\u003e\u003cp\u003eMethods:\u003c/p\u003e\u003cp\u003eInformed verbal consent was taken and a descriptive cross-sectional study was conducted among 27 female nurses out of 29 working in the emergency department at Kanti Children\u0026rsquo;s Hospital who consented were included in this study from May 5 to May 12, 2025. A structured questionnaire consisting of 20 multiple-choice questions was used to evaluate participants demographic profiles, triage knowledge, perceived practices. Data were analyzed using SPSS version 27, and chi-square tests were applied to assess associations. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eResults:\u003c/p\u003e\u003cp\u003eOnly 40.7% of participants had received formal triage training. The majority (74.1%) were aged 20\u0026ndash;30 years, and 63% had less than one year of emergency experience. Although 62.9% reported feeling very confident in triaging patients, only 40.7% correctly answered triage-related knowledge questions.There was a significant association p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 between formal training and triage knowledge accuracy. However, no statistically significant association was found between confidence levels and knowledge scores indicating that self-reported confidence does not reliably predict competence.\u003c/p\u003e\u003cp\u003eConclusion:\u003c/p\u003e\u003cp\u003eThe study revealed notable gaps in triage knowledge among emergency nurses, despite high self-reported confidence. Formal training was significantly associated with better triage knowledge, emphasizing the urgent need for structured training programs, 24-hour triage implementation, and regular competency assessments, and conduction of triage training before emergency posting. Bridging the gap between confidence and actual knowledge is essential for improving emergency care quality and patient outcomes in pediatric settings.\u003c/p\u003e","manuscriptTitle":"Knowledge and Practices of triage among Emergency department nurses at Kanti Children’s Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 09:55:22","doi":"10.21203/rs.3.rs-7164060/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0b53392-bb1e-47d9-87ea-14d5a88a36b9","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-10T07:23:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-22 09:55:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7164060","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7164060","identity":"rs-7164060","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}