G Model

COLEGN-379; No. of Pages 6 ARTICLE IN PRESS

Collegian xxx (2016) xxxxxx

Contents lists available at ScienceDirect

Collegian
journal homepage: www.elsevier.com/locate/coll

Triage and treat model of care: Effective management of minor

injuries in the emergency department
Patricia Van Donk a , Erin R. Tanti a, , Joanne E. Porter b
a
Nurse Practitioner, Emergency Department, Australia
b
School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill Campus, Victoria, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: The increasing demands on the emergency department (ED) can result in lengthy waits for
Received 18 March 2015 non-urgent category four and ve presentations. As a result, some patients are given denitive simple
Received in revised form 17 May 2016 treatments in the triage area and/or are given advice regarding self-care. Alternatively, patients may be
Accepted 28 May 2016
provided with information and directions to an external healthcare provider in order to receive care. This
Available online xxx
process is commonly referred to as a triage and treat model of care. This study aims to describe the
relationship between the triage and treat model of care and patient outcomes, including effectiveness,
Keywords:
length of stay, patient ow and patient satisfaction with emergency clinical care.
Triage
Minor injuries
Method: A cross-sectional descriptive study was used in this pilot study to determine the effectiveness
Emergency department of a triage & treat model of care in a single Regional ED. Convenience sampling was used with patient
Model of care follow up via a phone call to determine if any clinical complications or unexpected outcomes occurred
and to determine the level of satisfaction with the care received.
Results: One hundred and seventeen participants constituted the nal data set, with the majority of the
presentations in the 010 age range (38%). The mean length of stay was 19 min with the majority (97%)
presenting with wounds requiring interventions. Of the participants recruited to the study only 23%
(n = 27) required review following their triage and treat care and only three participants recruited to
the study expressed being dissatised, equating to a high level of satisfaction with this model of care. A
content analysis of the open ended responses yielded two positive themes (timely treatment and effective
model of care) and two negative themes (lack of education and dissatisfaction with care).
Conclusion: This pilot study has shown the triage and treat model of care to be a safe and effective option
for caring for participants presenting to the ED for the management of the minor wounds. The triage and
treat model of care improves patient satisfaction and ow through the emergency department while also
reducing waiting times making it an effective emergency model of care.
What is known?

Nurses do triage & treat and discharge patients presenting to the Emergency Department with minor
injuries informally.
A formalised model of care described as Triage and Treat is a relatively new modality for emergency
care in Australia.
Long waiting times in Emergency Departments are directly correlated to poor satisfaction with care.

What this paper adds?

Triage & treat is a time effective model of care for minor injury presentations
Triage and treat model of care appeared to improve patient satisfaction for emergency care of minor
wounds
Improves patient ow through the emergency department.

2016 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Corresponding author.
E-mail address: erintanti@gmail.com (E.R. Tanti).

http://dx.doi.org/10.1016/j.colegn.2016.05.003
1322-7696/ 2016 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
G Model
COLEGN-379; No. of Pages 6 ARTICLE IN PRESS
2 P. Van Donk et al. / Collegian xxx (2016) xxxxxx
1. Introduction
The introduction of the National Emergency Access Target
(NEAT) by the Australian Government for EDs aimed to address
the increasing demands for emergency care by improving patient
ow, decreasing overcrowding and improving quality of patient
care (Perera et al., 2014). Contributing to the problem of increased
demand in Regional Victoria is a growth in the number of ED pre-
sentations by a population unable to access primary health care
in the community, partly attributed to the decline in after-hours
General Practitioner (GP) services (Australian Medical Association,
2005 as cited by Combs, Chapman, & Busby, 2006). In Australia,
attendances to EDs have continued to increase by 17% over the last
5 years (Allen et al., 2015). The increasing demands on the ED can
result in lengthy waits for non-urgent presentations, a decrease in
patient satisfaction with a resultant increase in the did not wait to
be seen group of patients (Allen et al., 2015).
Conversely the see and treat or triage and treat model of
care aims to triage, treat and discharge patients soon after the
rst point of contact by an autonomous clinician for minor injuries
and illnesses (Parker, 2004). These patients are given denitive
simple treatments in the triage area and/or are given advice regard-
ing self-care or contact details of potential alternative healthcare
providers if they wish not to wait for ED treatment. Staff dedicated
to triage and treat patients must be able to work autonomously,
competently, making decisions about treatment, investigations
and discharge plans, usually carried out by a medical ofcer or
emergency nurse practitioner (Parker, 2004). A cross-sectional
descriptive study was used in this pilot study to determine effec-
tiveness, length of stay and level of patient satisfaction following a
triage & treat episode of care in a single regional ED.
2. Background
Reforms in Australian emergency care set patient care targets
of less than four hours from admission to discharge or trans-
fer (Khanna, Boyle, Good, & Lind, 2013). Fast track systems aim
to stream low acuity patients through a dedicated area in order
to reduce waiting times and length of stay. The success of this
type of stream has led to its wide use across many Australian
and International Emergency Departments (Kinsman et al., 2008;
OBrien, Williams, Blondell, & Jelinek, 2006; Maull, Smart, Harris,
& Karasneh, 2009; Ieraci, Digiusto, Sonntag, Dann, & Fox, 2008;
Sanchez et al., 2006). Designated fast track areas are usually staffed
by a mixture of senior clinicians such as emergency nurse prac-
titioners/candidates and medical ofcers supported by a senior
emergency nurse. Current literature suggests that dedicated senior
staff and patient selection are key factors to the success of fast track
(Considine, Kropman, & Stergiou, 2010).
Fast track, streaming and triage and treat were identied as
the three major models affecting patient ow in a review of liter-
ature detailing improvements in process redesigns for ED across
Australia, United Kingdom (UK) and North America (Combs et al.,
2006). A study in Western Australia reviewed the effects of the
introduction of a fast track model as a revised model of care, it
aimed to reduce patient delays in receiving treatment and reduc-
ing the number of patients that did not wait to be treated (Combs
et al., 2006). The introduction of a fast track area of care utilising
advanced practice by senior nursing staff was extremely successful
in reducing waiting times for Australasian Triage Scale (ATS) cate-
gories three, four and ve, and also reduced the number of patients
leaving without treatment (Combs et al., 2006).
Similarly, a study by Kwa and Blake (2008) investigated the
introduction of a fast track area within their ED, highlighting
improvements that were made to the length of stay for low acu-
Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
ity patients without risk to higher acuity patients. Likewise, the
introduction of streaming processes in an Australian tertiary adult
teaching hospital, demonstrated reductions in length of stay and
waiting times for discharged patients without increasing waiting
times for admitted patients (OBrien et al., 2006). Whilst, in an Aus-
tralian regional hospital the introduction of streaming processes
had similar success in improving the eight hour to admission and
four hour to discharge target times (Champion et al., 2008).
Undeland, Kowalski, Berth, and Gundrum (2010), assessed the
safety and appropriateness of antibiotic treatment in adult patients
with pharyngitis who opted for a nurse-only triage and treat algo-
rithm versus patients who underwent a physician-directed clinical
evaluation. The algorithm aimed to conrm the presence of a sore
throat as the primary symptom and identify potential complica-
tions that would warrant physician evaluation. The nurse-only
triage and treatment algorithm performed well and appeared to be
safe and cost-effective (Undeland et al., 2010). A study by Buchan,
Saihan, and Reynolds (2003) in the UK, reported on the success
of a nurse triage, diagnosis and treatment pathway for eye injury
patients in an outpatient ophthalmic ED. All patients deemed suit-
able for nurse triage management were assessed, managed and
discharged by the triage nurse. The authors revealed that the high
standard of diagnostic and management skills of the triage nurses,
led to improvements in time management of medical staff, waiting
times and patient satisfaction (Buchan et al., 2003).
A similar study in the Netherlands, Derkson et al. (2007) com-
pared the assessment and management of acute ankle and foot
injuries as managed by specialised emergency nurses (SEN) or
medical ofcers. This included the use of a ow diagram includ-
ing the use of the Ottawa ankle and foot rules. Whilst their study
focussed specically on the ability for their SENs to assess, treat
and discharge patients within this diagnostic group as safely as
their medical counterparts, this management was not performed at
triage. Rather their study proved that specialised emergency nurses
may be able to safely manage specic minor injuries, reducing
patient waiting times and improving patient satisfaction.
The see and treat model was developed from a process called
streaming which incorporates an admission or discharge stream.
The discharge stream includes fast track, which is usually brought
into operation during peak times and consists of a senior nurse
and senior doctor working with the patients in the triage area
to expediate treatment (Castille & Cooke, 2003; Cook, Wilson, &
Pearson, 2002; Parker, 2004; Rogers, Ross, & Spooner, 2004). The
triage and treat initiative was found to be well supported by staff,
waiting times were reduced, patient satisfaction improved and the
UK Department of Health targets were achieved; however most
programs were limited by the lack of additional resources and suit-
ably experienced staff (Castille & Cooke, 2003; Cook et al., 2002;
Parker, 2004; Rogers et al., 2004).
A systematic literature review undertaken by Oredsson et al.
(2011) reviewed studies reporting on patient ow processes such
as fast track, streaming, team triage, point of care testing and nurse
initiated x-ray at triage. Improvements in length of stay and wait-
ing times appeared modest in most studies, however the fast track
process appeared to demonstrate the best scientic evidence for
improvements in patient ow. Lee, Smith, and Jennings (2008)
further demonstrated the benets of triage related interventions
in two Victorian metropolitan EDs for the management of low
acuity lower abdominal pain. Showing that the initiation of treat-
ment such as analgesia and pathology performed in the triage area
improved efciency, patient satisfaction and waiting times. Simi-
larly, a study in the United States, highlighted the use of computer
system integration to improve the patient registration process aid-
ing in the prompt initiation of interventions such as pathology and
radiology requests (Chan, Killeen, Kelly & Guss, 2005). Further, an
emergency physician, immediately accessible to triage for deci-
G Model
COLEGN-379; No. of Pages 6 ARTICLE IN PRESS
P. Van Donk et al. / Collegian xxx (2016) xxxxxx
sion making particularly when beds were not available was also
deemed to increase efciency. Minor changes in patient registra-
tion and triage processes showed major improvements in reducing
the length of stay, waiting time and leaving before being seen statis-
tics (Chan et al., 2005).
Data obtained by Sullivan, Francis, and Hegney (2010), sup-
ports the view that triage nurses can work autonomously, with
nurses responsible for managing patients of a non-urgent nature
particularly in rural emergency settings. Further, Sullivan et al.
(2010) suggests that strategies for enabling nurses extended clini-
cal practice to manage non urgent emergency presentations would
require an ongoing development of skills and knowledge to enable
condent decision making in a more sustainable model of inter-
professional collaboration.
During 2012, a large regional emergency department in Victoria,
the focus for this paper, had 31,294 patient attendances. Of these
55% (n = 17,172) were allocated the Australasian Triage Score Cate-
gories 4 or 5, which included the diagnostic group of patients that
had an injury of a minor or uncomplicated nature with over half
being discharged home following treatment. It is anticipated that
a selection of these patients could be managed safely and effec-
tively by the triage nurse, using the triage and treat model of care.
This paper aims to demonstrate the effectiveness of the triage and
treat model of care in this pilot research study in a single regional
Victorian emergency department.
3. Method
3.1. Sample
There were 151 patients recruited into the study, of these 34
were later excluded if a researcher was unable to reach them
by phone on ve occasions or if ve months had elapsed since
the presentation or if they presented with behaviour suggestive
of alcohol/illicit drug intoxication, injuries with associated loss of
consciousness, involuntary mental health patients or patients not
deemed suitable for the triage and treat model of care. A total of
117 patients met the inclusion criteria; emergency department
admission, category 4 or 5, gave informed consent, and was one the
following four presentations; wound management, plaster of Paris
check, minor burn and suspected distal limb fracture. Participants
were required to complete a consent form, in the case of pae-
diatric presentations parental consent was obtained. All patients
were assessed as being suitable for the triage and treat model of
care based on clinical observations, the most common presenta-
tions included; wound management, plaster of Paris check, minor
burns and suspected distal limb fracture.
3.2. Design
A cross-sectional descriptive study with convenient sampling
was used in this pilot study to determine the number of complica-
tions following a triage and treat episode of care in the ED, the
length of stay and the level of patient and/or carer satisfaction with
that care. Treatment regimes using formulated ow charts based
on the latest research and current trends was used to guide patient
care thus ensuring the external validity for the study.
3.3. Data collection
Participants were contacted by phone within one month of
presenting to the emergency department using a contact number
provided on the consent form. The interview consisted of specic
questions that were developed to obtain the information needed to
answer the research question, thus establishing face validity. The
Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
3
interview questions were reviewed by an experienced Monash Uni-
versity researcher for review in order to provide content validity.
The interview questions were tested on a subset of potential partic-
ipants prior to commencing the pilot study. The participants were
asked yes/no questions regarding any clinical complications as a
result of the treatment, if they were satised or dissatised with
the timeliness in which they were treated and education regard-
ing required ongoing care and follow up. Initially they were asked
if they needed to present to either the Emergency Department or
their General Practitioner for review following their triage and treat
care. If the participant answered yes to requiring follow up care the
participant was asked to explain further.
The questions were divided into three categories, clinical
(related to the presentation and treatment) satisfaction (using a
Likert scale from dissatised to very satised) and an open ques-
tion (patients were given an opportunity to expand upon their
responses). Senior registered nurses (n = 20), who regularly work
in triage were provided with an education session on the project,
and were subsequently responsible for the recruitment of the par-
ticipants in this study. Participant demographic data was collected
from the patient notes and ow charts over a 12 month period from
March 2012 to March 2013.
3.4. Data analysis
Numerical and demographic data was entered into an excel
spreadsheet, and descriptive statistical analysis was undertaken.
Responses to the open ended question were added to the excel
spreadsheet and a content analysis conducted and conrmed by
the research team.
4. Results
There were a total of 393 triage and treat episodes of care to
the emergency department during the study period, of those 88%
(n = 347) were category 5 and 12% (n = 46) were category 4 pre-
sentations. The study recruited a total of 151 participants which
equated to a response rate of 38%, however 34 were later excluded
as they did not meet the inclusion criteria, therefore the nal
sample size was 117 presentations. The most common reason for
exclusion was an inability to reach the patient by phone follow-
ing 5 or more attempts. A total of 45 females and 72 male patients
were recruited to the study. The mean age of those recruited was 27
years (range 13 months to 67 years) for females and 20 years (range
10 months to 96 years) for males respectively. The majority of the
presentations were in the 010 (mean age 3) age range (n = 44)
which accounted for 38% of the participants in the triage and treat
study. Wounds requiring interventions including tissue adhesive
repair or steri-strip closure were the most common treatments in
the 010 age range. In the under 30- age group there were more
males (n = 56) than females (n = 28), however in the over 30 age
group there were more female (n = 17) than male (n = 16) patients.
There were a higher percentage of young males (48%) compared to
females (24%) presenting with minor wounds and injuries. Presen-
tation times were evenly distributed between 10 am and 10 pm.
The total number of study participants recruited compared to the
total number of triage and treat presentations for the 12 month
period of data collection, is represented in Fig. 1.
The length of stay for triage and treat patients ranged from one
minute to 80 min and did not follow a normal distribution curve
which is understandable considering the constantly changing envi-
ronment in an Emergency Department and the differing diagnostic
groups requiring different lengths of time to complete assessments
and treatments. The median length of stay was 17 min with an
interquartile range of 14 (rst quartile = 9 and third quartile = 23)
G Model
COLEGN-379; No. of Pages 6 ARTICLE IN PRESS
4 P. Van Donk et al. / Collegian xxx (2016) xxxxxx

Time of Presentaon - Triage & Treat

60

50

40 37
40
36
43 31
30 23
21
20
19

10 16 16 17 19 17
12 8 13
5 9 7
0 1 1
0 2
0

recruited to study all triage & treat

Fig. 1. Number of triage and treat presentations vs time of presentation.

(Alcula Online Calculators, 2015). The mean length of stay was
19 min, with a standard deviation of 14.3. Of the patients recruited
to the study, 30% (n = 35) had a length of stay between 0 and 10 min,
38% (n = 46) had a length of stay between 11 and 20 min and 19%
(n = 22) between 21 and 30 min. The remaining 13% (n = 14) had a
length of stay greater than 30 mins. Wound management was the
most common triage and treat presentation, accounting for 83%
(n = 97) of the participants recruited for the study (Fig. 2).
Of the participants recruited to the study, 23% (n = 27) required
review following their triage and treat care, of these 63% (n = 17)
were a planned review in the emergency department and 37%
(n = 10) were unplanned. Of the 10 unplanned reviews, 5 were
related to wound dehiscence, 4 to wound infection/poor wound
healing and one was a POP that required replacement. Of the 8%
(n = 9) of patients who presented with minor burns none experi-
enced any complications or unplanned reviews and all stated that
they were satised with their triage and treat care.
All patients were given the opportunity to provide additional
comments in the open ended question during the interview. Out of
the total 117 participants 12% (n = 15) provided a response to this
question. Two positive themes and two negative themes, emerged
from the content analysis; timely treatment (n = 5), triage and treat
is an effective model of care (n = 4) and the negative themes were
a perceived lack of education (n = 3) and dissatisfaction with care
(n = 3).
Participants stated that they found the triage and treat model of
care sped up their transition through the emergency department
resulting in timely treatment and expedited discharge times. One
participant stated quickest visit ever to the ED (P 135) while another
commented, Happy to be treated so quickly when the department
was obviously very busy (P 82). Another participant remarked . . .
the quick treatment enabled speedy discharge to allow us to get home
to care for our disabled daughter whom we had left at home (P 100).
Further comments such as fantastic way to look after simple things
(P 88) and I wish all my visits to ED were like this one (P 64), . . . great
service (P 5) and . . .great idea to free up the doctors for more compli-
cated things (P 66) were positive comments about the effectiveness
of the triage & treat model of care. There was a perceived lack of
education regarding ongoing management of wounds (n = 3). Two
participants were unsure if they had been provided education and
another stated no education was provided (P 48) these three par-
ticipants subsequently required an unplanned ED review. Although
in general, the comments were overwhelmingly positive, one par-
ticipant made comment about the . . .grumpy nurse (P 26) who
provided their care during the ED presentation. Another participant
felt her child should have received an x-ray on initial presentation

Fig. 2. Participant diagnosis.

Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
G Model
COLEGN-379; No. of Pages 6 ARTICLE IN PRESS
P. Van Donk et al. / Collegian xxx (2016) xxxxxx
despite an x-ray performed by her GP one week later showing no
fracture. The remaining participants (n = 102) stated that they were
satised with the care that they had received.
5. Discussion
A triage and treat model of care for minor injuries has been
shown to improve patient satisfaction, reduce waiting times and
improve the patient ow through emergency departments (Combs
et al., 2006), this is consistent with the ndings from this pilot study
in a single regional emergency department. There remains a gap the
in current literature with regard to possible benets of a triage and
treat model of care (Parker, 2004).
Both Undeland et al. (2010) and Buchan et al. (2003), show that
management of low acuity illnesses or injury such as pharyngitis
or eye injury could be safely managed by the triage nurse using an
algorithm to direct care, which may suggest that other minor ill-
nesses or injuries could be included in the program. These ndings
are similar to the current pilot study which noted some improve-
ment to the patient ow through the emergency department,
patient satisfaction and a reduction to the number of complications
for patients presenting with a minor wound. The triage and treat
model was identied as being appropriate for the care of additional
minor injuries such as burns, plaster checks and suspected frac-
tures. Undeland et al. (2010) and Buchan et al. (2003) also noted that
the triage and treat model of care, together with developed algo-
rithms, had a wider application for minor injuries in the emergency
department.
Improved efciency to patient ow, patient satisfaction and
waiting times less than 30 min constituted the major ndings of
the current pilot study, this is similar to ndings by Lee et al.
(2008) who noted that the initiation of analgesia and pathology at
triage improved efciency, patient satisfaction and reduced wait-
ing times for patients presenting with low acuity lower abdominal
pain. These ndings were supported by the systematic review of
the literature by Oredsson et al. (2011) who reported that the triage
and treat model care was among a number of other models, such
as fast track that were identied as reducing the length of stay, and
waiting times while improving patient ow in the department.
In order for the successful implementation of a triage and treat
model it is important to ensure that all staff are suitably experi-
enced and have the necessary resources to ensure it is a sustainable
model of care (Cook et al., 2002; Parker, 2004). The staff in the
current pilot study were not the participants, hence no data was
collected from the staff, therefore the level of expertise required to
run a triage and treat model was not ascertained. It was noted by
the researchers that participant recruitment was enhanced by the
more senior emergency staff working in triage.
6. Limitations of the study
There were difculties recruiting and maintaining the senior
emergency nurses interest in the project thus extending the data
collection period and may have been responsible for a number of
missed potential participants. There were only a small number of
participants recruited into the non-wound category and as a result
were not able to make any conclusions. A larger study of non-
wound related category 4 and 5 patients is required to ascertain
the success of a triage and treat model of care.
The study was conducted in a single site in a regional setting; it
is possible that a multisite study could provide different outcomes
as the patient population, workload and stafng mix may differ. It
is possible that with more availability of senior medical staff and
an established fast track stream there is not the same demand for
Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
5
this type of model of care in Metropolitan emergency department
settings.
It is possible that the high level of satisfaction could be attributed
to the inability to access GP or community based services as anecdo-
tally patients often make the comment that they could not obtain a
GP appointment. Unfortunately this information was not collected
so cannot be reported and may have skewed the patient satisfac-
tion section of the study. In future studies it would be useful to
determine if the patient had attempted to access GP or community
bases services prior to attending the ED for treatment. Participant
comments did suggest the triage and treat visit was the quickest
treatment received suggesting that this visit was more positive
than previous visits where the care was undertaken in the more
traditional medical model.
7. Recommendations
This research may provide impetus for others involved in sim-
ilar triage and treat models of care to perform further studies to
support and formalise practice outcomes. The researchers are con-
sidering expansion of the program to include other traditional fast
track diagnostic groups such as minor allergic reaction and uncom-
plicated urinary tract infections, to assist with fast track ow as fast
track often only has one doctor allocated per shift and traditionally
has the largest patient throughput.
Through publication of the results of this study, the researchers
hope that evidence of the advantages (reduced length of stay and
improved ED ow); lack of clinical complications and patient sat-
isfaction will encourage a formalisation of this model of care in
other organisations and the expansion into other diagnostic groups.
The researchers recommend further research in this area and are
encouraged to consider expansion of the triage & treat model of
care into areas of minor illness using care owcharts or pathways.
8. Conclusion
This pilot study has shown that a triage and treat model of care
is a safe and effective option for patients presenting to emergency
departments with minor wounds. It demonstrates a positive trend
towards reduced length of stay in the department and improved
patient satisfaction without any signicant complications. The
triage and treat model of care improves the management of minor
wounds, reduces waiting and treatment times, therefore improving
patient ow through the emergency department.
Human research ethics approval
This study adhered to the National Statement on the conduct
of Human Research by the Australian National Health and Medical
Council and was approved by the Hospital Research Ethics Commit-
tee. Patient condentiality was maintained at all times throughout
the study, all data collected was allocated a number identier,
known only to the research team. All data collection forms and
records were stored in a secure ofce within the emergency depart-
ment which could only be accessed only by the research team.
The research participants were supplied with written information
regarding the proposed research by the triage nurse together given
a verbal explanation, prior to signing the consent form. Participants
were able to withdraw from the study at any time
Funding
This study received no funding or nancial support from an
internal or external agency.
G Model
COLEGN-379; No. of Pages 6 ARTICLE IN PRESS
6 P. Van Donk et al. / Collegian xxx (2016) xxxxxx
Provenance and conicts of interest
There are no conicts of interest to declare. This paper was not
commissioned.
Acknowledgements
The authors would like to acknowledge and thank the nurs-
ing staff in the emergency department at the hospital where the
study took place as well as Frank Marino Nurse Practitioner, for his
assistance during data collation phase.
References
Alcula Online Calculators. (2015). Statistics calculator: interquartile range.. Retrieved
from:. http://www.alcula.com/calculators/statistics/interquartile-range
Allen, P., Cheek, C., Foster, S., Ruigrok, M., Wilson, D., & Shires, L. (2015). Low acuity
and general practice-type presentations to emergency departments: a rural
perspective. Emergency Medicine Australasia., 27, 113118.
Buchan, J. C., Saihan, Z., & Reynolds, A. G. (2003). Nurse triage, diagnosis and
treatment of eye casualty patients: a study of quality and utility. Accident and
Emergency Nursing, 11, 226228.
Castille, K., & Cooke, M. (2003). One size does not t all. View 2. Emergency
Medicine Journal, 20, 120122.
Champion, R., Kinsman, L., Lee, G., Martin, M., Masman, K., May, E., et al. (2008).
Assessing the impact of streaming in a regional emergency department.
Emergency Medicine Australasia, 20, 221227.
Chan, T. C., Killeen, J. P., Kelly, D., & Guss, D. A. (2005). Impact of rapid entry and
accelerated care at triage on reducing emergency department patient wait
times lengths of stay, and rate of left without being seen. Annals of Emergency
Medicine, 46(6), 491497.
Considine, J., Kropman, M., & Stergiou, H. (2010). Effect of clinician designation on
emergency department fast track performance. Emergency Medical Journal, 27,
838842.
Cook, M., Wilson, S., & Pearson, S. (2002). The effect of a seperate stream for minor
injuries on accident and emergency waiting times. Emergency Medical Journal,
19, 2830.
Combs, S., Chapman, R., & Bushby, A. (2006). Fast track; one hospitals journey.
Journal of Accident and Emergency Nursing, 14, 197203.
Derkson, R. J., Bakker, F. C., de Lang- de Klerk, E. M., Spaans, I., Heilbron, E. A.,
Veenings, B., et al. (2007). Specialized emergency nurses treating ankle and
Please cite this article in press as: Van Donk, P., et al. Triage and treat model of care: Effective management of minor injuries in the
emergency department. Collegian (2016), http://dx.doi.org/10.1016/j.colegn.2016.05.003
foot injuries:a randomized controlled trial. The American Journal of Emergency
Medicine, 25, 144151.
Ieraci, S., Digiusto, E., Sonntag, P., Dann, L., & Fox, D. (2008). Streaming by case
complexity: evaluation of a model for emergency department fast track.
Emergency Medicine Australasia, 20(3), 241249.
Khanna, S., Boyle, J., Good, N., & Lind, J. (2013). New emergency department quality
measure: from access block to National Emergency Access Target compliance.
Emergency Medicine Australasia, 25, 565572.
Kinsman, L., Champion, R., Lee, G., Martin, M., Masman, K., May, E., et al. (2008).
Assessing the impact of streaming in a regional emergency department.
Emergency Medicine Australasia, 20, 221227.
Kwa, P., & Blake, D. (2008). Fast track: has it changed patient care in the emergency
department? Emergency Medicine Australasia, 20, 1015.
Lee, G., Smith, S., & Jennings, N. (2008). Low acuity abdominal pain in the
emergency department: still a long wait. International Emergency Nursing, 16,
94100.
Maull, R. S., Smart, P. A., Harris, A., & Karasneh, A. Al-F. (2009). An evaluation of
fast track in A&E: a discrete event simulation approach. The Service Industries
Journal, 29(7), 923941.
OBrien, D., Williams, A., Blondell, K., & Jelinek, G. (2006). Impact of streaming fast
track emergency department patients. Australian Health Review, 30(4),
525532.
Oredsson, S., Jonsson, H., Rognes, J., Lind, L., Goransson, K. E., Ehrenberg, A., et al.
(2011). A systematic revew of triage-related interventions to improve patient
ow in emergency departments. Scandinavian Journal of Trauma, Resuscitation
and Emergency Medicine, 19(43).
Parker, L. (2004). Making see and treat work for patients and staff. Emergency
Nurse, 11(9), 1617.
Perera, M. L., Davie, A. W., Gnanaswaran, N., Giles, M., Liew, D., Ritchie, P., et al.
(2014). Clearing emergency departments and clogging wards: National
Emergency Access Target and the law of unintended consequences. Emergency
Medicine Australasia, 26, 549555, alle.
Rogers, T., Ross, N., & Spooner, D. (2004). Evaluation of a see and treat pilot study
introduced to an emergency department. Accident and Emergency Nursing,
2427.
Sanchez, M., Smally, A., Grant, R. J., Jacobs, L. M., Smally, A. J., Grant, R. J., et al.
(2006). Effects of a fast-track area on emergency department performance.
Journal of Emergency Medicine, 31(1), 117120.
Sullivan, E., Francis, K., & Hegney, D. (2010). Triage, treat and transfer:
reconceptualising a rural practice model. Journal of Clinical Nursing, 12(1),
16251634.
Undeland, D., Kowalski, T., Berth, W., & Gundrum, J. (2010). Appropriately
Prescribing antibiotics for patients with pharyngitis: a physician based
approach v/s a nurse only triage and treat algorithm. Mayo Clinical Process,
85(11), 10111015.