Triage Effectiveness: A framework for quantifying the effect of emergency triage prioritization

Triage Effectiveness: A framework for quantifying the effect of emergency triage prioritization | 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 Triage Effectiveness: A framework for quantifying the effect of emergency triage prioritization André Johansson, Viktoria Fodor, Jakob Lundager Forberg, Anna Ekwall, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7922938/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Emergency departments use triage to identify time-critical patients and reduce waiting times by assigning higher priority. However, no existing method directly measures this core clinical function. We developed and validated Triage Effectiveness (TE) as a framework for quantifying how well triage systems reduce waiting times for time-critical patients. Methods Using data from 463,327 visits across eight emergency departments, we developed TE as a scale where 0% equals a first-come-first-serve strategy (no triage) and 100% equals perfect prioritization. The framework includes two complementary measures: 1. Waiting Time-based TE (WTE) measuring actual waiting time reduction, where 100% represents zero waiting time, and 2. Rank-based TE (RTE) measuring queue position improvement where 100% represents placement first in queue. Both can be calculated as theoretical TE (based only on priorities) and observed TE (actual clinical performance). We validated WTE and RTE calculations using analytical queueing models adapted for classification uncertainty and assessed transferability across hospitals. Results Queue theory validation showed strong alignment with both WTE and RTE calculations, with RTE demonstrating greater robustness and less sensitivity to ED utilization patterns. TE increased with accuracy and produced negative values when triage performance was worse than chance. When applying the framework we found substantial gaps between theoretical and observed TE across all emergency departments, indicating significant post triage reprioritization. Conclusions The TE framework provides the first method for directly measuring the effectiveness of triage while utilizing full ordinal priority information. TE can assess the effectiveness of initial triage and the impact of post-triage re-prioritization. Triage Effectiveness Priority Triage Priority Queues Emergency Care Performance Metrics Waiting Time Analysis Patient Prioritization Quality Indicators Queue Theory Full Text Additional Declarations No competing interests reported. Supplementary Files BMCAdditionalfile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 May, 2026 Reviews received at journal 01 May, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviews received at journal 20 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Nov, 2025 Editor invited by journal 24 Oct, 2025 Editor assigned by journal 23 Oct, 2025 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 22 Oct, 2025 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7922938","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587861181,"identity":"06b0c943-8003-49b5-a93c-6f360bd579e2","order_by":0,"name":"André 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Methodology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Triage Effectiveness, Priority Triage, Priority Queues, Emergency Care, Performance Metrics, Waiting Time Analysis, Patient Prioritization, Quality Indicators, Queue Theory","lastPublishedDoi":"10.21203/rs.3.rs-7922938/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7922938/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEmergency departments use triage to identify time-critical patients and reduce waiting times by assigning higher priority. However, no existing method directly measures this core clinical function. We developed and validated Triage Effectiveness (TE) as a framework for quantifying how well triage systems reduce waiting times for time-critical patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing data from 463,327 visits across eight emergency departments, we developed TE as a scale where 0% equals a first-come-first-serve strategy (no triage) and 100% equals perfect prioritization. The framework includes two complementary measures: 1. Waiting Time-based TE (WTE) measuring actual waiting time reduction, where 100% represents zero waiting time, and 2. Rank-based TE (RTE) measuring queue position improvement where 100% represents placement first in queue. Both can be calculated as theoretical TE (based only on priorities) and observed TE (actual clinical performance). We validated WTE and RTE calculations using analytical queueing models adapted for classification uncertainty and assessed transferability across hospitals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eQueue theory validation showed strong alignment with both WTE and RTE calculations, with RTE demonstrating greater robustness and less sensitivity to ED utilization patterns. TE increased with accuracy and produced negative values when triage performance was worse than chance. When applying the framework we found substantial gaps between theoretical and observed TE across all emergency departments, indicating significant post triage reprioritization.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe TE framework provides the first method for directly measuring the effectiveness of triage while utilizing full ordinal priority information. TE can assess the effectiveness of initial triage and the impact of post-triage re-prioritization.\u003c/p\u003e","manuscriptTitle":"Triage Effectiveness: A framework for quantifying the effect of emergency triage prioritization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 12:05:02","doi":"10.21203/rs.3.rs-7922938/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T20:38:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-01T15:13:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184954125218064800148341477847981591781","date":"2026-04-20T11:38:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T16:24:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132608153657519284916754246353865021199","date":"2026-02-08T23:39:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108666130096644505458957350390441123957","date":"2026-02-03T19:59:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-03T19:47:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-24T19:42:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T06:59:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-23T06:58:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Research Methodology","date":"2025-10-22T11:16:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-research-methodology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmrm","sideBox":"Learn more about [BMC Medical Research Methodology](http://bmcmedresmethodol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmrm/default.aspx","title":"BMC Medical Research Methodology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"79411985-470a-4090-b0aa-a9672b4937bd","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T20:38:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-01T15:13:37+00:00","index":70,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T11:26:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 12:05:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7922938","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7922938","identity":"rs-7922938","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}