Expectations of emergency patients regarding triage system knowledge upon arrival: an interpretive study

A descriptive, cross-sectional design was utilized.

The study was conducted in the emergency department at various biggest public hospitals located in the capital of Jordan (Amman) which provides care for many patients with different conditions. These hospitals are administratively affiliated with the Ministry of Health and are accredited as educational hospitals by the Jordanian Medical Council and the Arab Council for Medical Specializations. These hospitals serve about 4.5 million people (as per the 2021 census), and they have different EDs which provide care for 45% of the Jordanian population with different medical conditions which could reach over 12,000 patients daily (Ministry of Health, 2023). Convenience sampling was used to recruit the participants. The minimum sample size was 619 participants based on the G* Power software calculation (power of 0.95, α = 0.05, medium effect size 0.2) [18].

A self-reported questionnaire that consists of two tools was used. The first part is composed of a socio-demographic data sheet that includes age, sex, educational level, current job, marital status, residency place, nationality, and monthly income in Jordanian dinar. The second part is concerned with the Discounted Cash Flow Interview (DCF) survey that was developed by Seibert et al. [19] in the USA to assess the ED visitor’s knowledge about the ED process and hospital function. An Arabic version of Alhabdan et al. [20] was used in this study. This tool was used to measure the patient’s awareness of the quality of nursing care in hospitals. The awareness section included four domains. However, two domains were used to accomplish the purpose of this study, namely, knowledge of the emergency triage system (five items,two open-ended and three multiple-choice questions) and the ED visitor’s expectations that have questions with varied answers, as they contain open-ended answers and multiple-choice questions. This tool was valid and reliable, with a Cronbach’s alpha of 0.77–0.83 [19, 20].

The study was approved by Al-Zaytoonah University of Jordan (No. 2024–2023/133/03) and the selected hospital (No. MOH/REC/2023/480). Informed consent was included with full details of the purpose, benefits, risks, and time required to fill out the questionnaire. Data were kept secure and anonymized.

After getting approval from the required parties, a meeting with the head nurse in the emergency department was held to explain the purpose of the study. An interview with patients took place in the triage room. The participants signed the consent form and completed the questionnaire. The researcher stored the completed questionnaires in a sealed envelope, ensuring that only the researcher had access to the data. The study was conducted from June to September 2023, with all envelopes stored in the researcher’s office.

The mean age of the participants was M = 38.1 (SD = 12.9), and the age of the participants varied from 18 to 89 years. More than half of the participants were male (n = 383, 52.8%) and married (n = 425, 58.5%). More than half of the participants hold a diploma and higher degree of education (n = 399, 54.9%), while there were (n = 126, 17.4%) illiterate. The majority of participants (n = 649, 89.4%) were Jordanians and lived in the capital of Jordan, Amman (n = 430, 59.2%), as shown in Table 1.

Regarding participants’ knowledge of the triage system, the majority of participants (n = 445, 61.3%) did not know what the triage system entailed. Over half of the participants (n = 424, 58.4%) are aware of what an educational hospital is and that they are currently receiving medical care services. Most patients (n = 434, 59.8%) know why some patients were taken to a room before others (even though they may not have waited a long time). The majority of participants think the triaging system is fair enough for all (n = 534, 73.6%). Nonetheless, 61.3% (n = 445) of the participants were ignorant of the meaning of triage, as shown in Table 2.

In terms of ED visitor’s expectations, most of the participants did not want to know how long other patients waited (n = 446, 61.4%). However, many of the participants agreed to hear updates about possible delays (n = 435, 59.9%); of them, 67.9% (n = 493) wanted to know updates about delays every half an hour. The majority of people (n = 231, 31.8%) who preferred to hear from healthcare practitioners about any updates regarding delays were nurses. Further, the majority of participants want to know further information about how the ED works (n = 601, 82.8%), especially about hypertension, diabetes, or cancer (n = 565, 77.8%) and how to find a primary care provider (n = 569, 78.4%). For the overall perception, participants reported that being presented in a teaching hospital might affect the care provided for them as they believe that teaching hospitals have more emphasis on patient education (n = 426, 58.7%), as shown in Table 3.

The chi-square test was used to assess the relationship between participants’ knowledge about the triage system during the patient’s ED visit and demographical data which revealed a significant relationship between the overall perception of knowing what a teaching hospital is and patients’ educational level (X² = 11.9, P < 0.003), current job (X² = 25.2, P < 0.001), nationality (X² = 7.20, P < 0.007), and family income (X² = 15.9, P < 0.001). Knowing if this hospital is a teaching hospital was significantly associated with education level X² = 16.5, P < 0.001), current job (X² = 22.9, P < 0.001), nationality (X² = 9.39, P < 0.002), and family income (X² = 9.20, P < 0.010).

Furthermore, the participants’ education level (X² = 17.9, P < 0.000), current job (X² = 18.5, P < 0.000), and nationality (X² = 10.3, P < 0.001) were substantially correlated with their ability to understand why certain patients are transported to a room before others even though they may not have waited as long as they were waiting. Furthermore, there was a strong correlation found between patients’ education level (X² = 6.90, P < 0.032), present job (X² = 13.4, P < 0.004), and nationality (X² = 20.7, P < 0.001) and the belief that some patients are taken to a room before others. Knowing what triage means also had a significant relationship with participants’ education level (X² = 15.6, P < 0.001), current job (X² = 14.9, P < 0.002), marital status (X² = 7.26, P < 0.027), and nationality (X² = 7.15, P < 0.008). However, the other items of the knowledge about triage system variables were not significantly concerning their sociodemographic variables (P > 0.05), as shown in Table 4.

Furthermore, the chi-square test was used to assess the relationship between sociodemographic data and ED visitors’ expectations. The results showed that there was a statistically significant relationship between participants who desired to know how long other patients have been waiting and their age (X² = 4.02, P < 0.045), education level (X² = 13.5, P < 0.001), and current job (X² = 9.90, P < 0.019). A desire to hear updates about delays was statistically significantly correlated with a current job (X² = 23.8, P < 0.000), while the time for hearing those updates is significantly correlated with the current job (X² = 31.63, P < 0.000) and place of residence (X² = 14.4, P < 0.002). The desire to know more information about how the ED functions were significantly related to gender (X² = 27.1, P < 0.000) and residency place (X² = 4.64, P < 0.031) is shown in Table 5.

Furthermore, periodic updates from the ED staff about the delays were statistically related to participants’ age (X² = 3.29, P < 0.049), current job (X² = 28.4, P < 0.019), marital status (X² = 8.93, P < 0.012), and place of residence (X² = 9.94, P < 0.002). Also, getting general information about common illnesses such as high blood pressure, diabetes, or cancer prevention was related to participants’ residency place (X² = 5.90, P < 0.015). Receiving general information about the healthcare system and how to find a primary care provider was associated with participants’ educational level (X² = 19.15, P < 0.010). Acquiring general information about triage and ED functions was related to participants’ gender (X² = 3.48, P < 0.042). The medical conditions (e.g., stroke, heart attack) were significantly related to their education level (X² = 5.81, P < 0.045) and nationality (X² = 8.57, P < 0.003). However, the remaining items were not significantly associated with visitors’ expectations about ED variables (P > 0.05), as shown in Table 6.

The current study has significant implications for healthcare practice, research, and policymakers. It is crucial to refine the triage concept to improve patient safety and ensure timely and appropriate delivery of medical care while taking into account available resources and survival probabilities. The study also highlights the need to enhance patients’ understanding of the triage system and the factors that influence their experiences during ED visits. Healthcare practitioners can use these findings to create interventions that increase patients’ awareness, improve treatment quality, and reduce wait times. Additionally, the study shows that patients’ access to timely and suitable medical care, considering available resources and survival prospects, significantly affects their understanding of the triage system and factors that shape their encounters during ED visits. Further research could explore ways to enhance triage awareness among patients and promote a culture of triage awareness. Nursing managers and policymakers should prioritize patient awareness of the triage system at EDs. This requires a strong commitment from healthcare institutions to prioritize patient triage system awareness as a core value, supported by investments in resources and training to strengthen these principles.

Several limitations should be acknowledged in our study. Firstly, our study was conducted in a single public hospital, which might constrain the applicability of the results to diverse healthcare settings or cultural contexts. Variances in healthcare systems and the implementation of triage protocols across different contexts may affect the study’s generalizability. Secondly, the utilization of self-reported data poses a potential limitation, given the susceptibility to social desirability bias, which might influence participants to present responses they believe are favorable to researchers or peers. Finally, the cross-sectional design of the study restricts the establishment of causal relationships between patients’ awareness of the triage system and their satisfaction with nursing care in the ED. To discern causality, longitudinal studies would be necessary.