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Published 2021 | Version v1.0.0
Journal Article Open

NO WAIT: new organised well-adapted immediate triage: a lean improvement project


Long waiting times in the emergency department (ED) are associated with decreased patient satisfaction and increased morbidity and mortality. Triage may be a contributing factor to prolonged wait times in the ED. At Alhada Armed Forces Hospital (Taif, Saudi Arabia), patients other than level 1 and 2 on the Canadian Triage and Acuity Scale are requested to wait until triage. During peak hours (08:0022:00), the waiting time prior to triage is prolonged, and several patients leave the ED before triage. In this project, a multidisciplinary team was assembled to revise patient flow from the time of arrival at the ED to the time of triage. Lean methodology was used to identify the redundancies and design a seamless flow process for ED patients. Through reorganising the triage area using minimal additional resources, the project team devised a novel floor plan for the triage area which provided a unique patient flow in the ED. The median patient wait time from arrival to triage was reduced from 27 min to 4.09 min and the percentage of patients leaving the ER before triage was reduced to 0%. This project is the first of its kind in Saudi Arabia, as well as in the Gulf region, and provides a radical solution to the problem of patient waiting in the ED during peak hours.


original_citation: Elkholi A, Althobiti H, Al Nofeye J, et al. NO WAIT: new organised well-adapted immediate triage: a lean improvement project. BMJ Open Quality 2021;10:e001179. doi:10.1136/bmjoq-2020-001179


The project team would like to thank Maj Gen Dr Yasser Babier, Director of the Taif Region Hospital, who believed in the project and allocated the resources necessary to perform this intervention. In addition, thanks are due to Dr Najlaa Al Malki, assistant hospital director for health affairs, for her support and assistance.


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March 30, 2023
March 30, 2023