Keywords
Doctor-in-triage
Waiting times
How to Cite
Abstract
Background. Lengthy waiting times are a frequent challenge faced by patients seeking care in South African (SA) healthcare facilities. Placing a doctor in triage has been extensively tested in higher-income countries as a way to reduce waiting times, while also providing numerous patient care opportunities. Very little research pertaining to resource-restricted settings has been conducted, with limited results showing no significant improvement in waiting times owing to many confounding factors.
Objectives. To determine whether placing a doctor in triage resulted in a decrease in patient waiting times and improved patient care in an SA setting.
Methods. A mixed-methods study design was used. The quantitative arm compared the waiting times of two patient populations (1 - 31 March 2023 and 1 - 31 March 2024) before and after implementation of a doctor in triage. The qualitative arm was an online survey sent to staff members working in the emergency centre (EC) or triage during the study period, gathering their views on the system and its impact.
Results. Waiting times did not decrease with the introduction of a doctor in triage. Instead, an increase of 13.4 minutes from triage to consultation time was observed, possibly owing to various confounding factors such as staff shortages, budget cuts and resource restriction. However, qualitative data indicated that the majority of the survey participants found the system to be practical, noted their observation of improved patient flow, expediting of seriously ill patients and the ability to quickly consult and discharge patients, and gave ideas for improvement of the system. Challenges included short staffing in the EC, burnout, and bottlenecks due to over-triaging.
Conclusion. Placing a doctor in triage increased the waiting time for patients by 13.4 minutes, and still caused an increase of 7 minutes with a significant confounder corrected. While staff members perceived that the system may have advantages for patient care, they mentioned that it requires staff training, patient education, and the execution of standard procedures. Further research with multiple study locations, including direct opinions of patients and improved standard operating procedures, is recommended before it can be decided whether the system is advantageous.
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