An integrative review: triage protocols and the effect on ED length of stay

J Emerg Nurs. 2013 Jul;39(4):398-408. doi: 10.1016/j.jen.2011.12.016. Epub 2012 Apr 16.


The purpose of this integrative review is to identify the effectiveness of using triage protocols to decrease ED length of stay. The review method described by Ganong was used to guide the review process. Data sources included CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline, the Cochrane Library, Mosby's Nursing Consult, and the National Guideline Clearinghouse. In addition, reference lists of all articles were reviewed, 3 authors of previous articles were contacted for more current or updated work, and a hand search of the Journal of Emergency Nursing was conducted. The search generated 56 articles, 8 of which met inclusion criteria. Data were interpreted and evaluated by use of a data summary sheet. Key conclusions drawn from the appraisals included that a decrease in length of stay was related to protocol use and nurses were able to initiate diagnostic testing and treatments appropriately. These conclusions apply to acuity levels 3 and 4, which require either little or no testing or require testing to facilitate a disposition decision. The implications for nursing are that appraisals of evidence lead to better practice decisions, protocols can provide greater nursing autonomy and satisfaction, and protocols are able to increase the facilitation of patient care in the emergency department.

Publication types

  • Review

MeSH terms

  • Diagnostic Tests, Routine / methods
  • Emergency Nursing / methods*
  • Emergency Service, Hospital*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Practice Guidelines as Topic*
  • Triage / methods*