The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study.

BACKGROUND: The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. OBJECTIVE: This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. METHODS: We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. RESULTS: The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. CONCLUSIONS: Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Ranibizumab prefilled syringes: benefits of reduced syringe preparation times and less complex preparation procedures.

PURPOSE: A recently developed ranibizumab prefilled syringe (PFS) eliminates several preparatory steps versus the standard vial-based method, and is expected to reduce syringe preparation time (SPT) and enhance procedural simplicity for intravitreal injections. METHODS: Syringe preparation times for the ranibizumab PFS and vial were recorded during standard treatment sessions at 2 centers, without randomization. The duration of each step in preparing the syringe was recorded. At each center, total SPT (mean total duration of all syringe preparation steps) for each method was compared using a 2-tailed t test. RESULTS: In total, 97 SPTs were analyzed across both centers. Center 1 SPTs were 46 seconds (PFS) versus 75 seconds (vial; difference, 29 seconds; p<0.001). Center 2 SPTs were 46 seconds (PFS) versus 63 seconds (vial; difference, 17 seconds; p<0.001). This equates to a 27%-39% reduction in SPT when using the PFS rather than the vial, resulting mostly from the reduced number of syringe preparation steps associated with the PFS. CONCLUSIONS: Syringe preparation times for ranibizumab intravitreal injections are significantly shorter with the PFS than with the vial. The time saved by using the PFS may benefit physicians and nurses, and the simplicity of the injection preparation process with the PFS is advantageous.