This study aims to evaluate a pre-post intervention adding an early management decision at the end of the triage process to improve patient throughput. The intervention consists of adding digital checkboxes to the electronic triage system, providing nurses with formalized options for anticipated management based on patient acuity. The study compares a pre-intervention phase (May 1st to July 31st, 2026) with a post-intervention phase (May 1st to July 31st, 2027) to naturalize seasonal confounders. The primary outcome is the total Emergency Department Length of Stay (ED LOS).
All patients over 18 years who registered at the admission desk during the study period.
Arrival by emergency medical services (ambulance or helicopter)
Patient trajectory bypassing the standard nurse-led triage process
Patient directly referred to another service of the hospital after triage (gynecology, ophthalmology, etc.).
The study population comprises all adult patients (over 18 years old) presenting to the emergency department of the cantonal hospital in Fribourg (HFR), Switzerland, during the predefined study periods (Phase 1 and Phase 2). The HFR is a university teaching and research hospital that manages approximately 41,000 ED visits annually.
Cohort
Prospective
Digital Anticipatory Protocols at Triage
Procedure/SurgeryThe intervention consists of adding digital checkboxes to the electronic triage system. This provides nurses with formalized options for anticipated management based on patient acuity, aiming to encourage and document anticipatory actions while stimulating clinical reasoning.
Total Emergency Department Length of Stay (ED LOS).
The time interval from the completion of the patient's administrative registration to their physical departure from the ED
Left without being seen (LWBS)
Proportion of patients who registered at the ED admission desk and left before receiving a medical screening exam or an evaluation by a physician
30-day mortality
Assessed through institutional medical records to evaluate safety
Intesive Care Unit (ICU) transfers
Proportion of patients transferred to the Intensive Care Unit (ICU) immediately and within 7 days after the ED visit
Time From Triage Assessment to Disposition Decision
The time interval, measured in minutes, elapsed from the beginning of the nursing triage assessment to the exact moment a definitive disposition decision (e.g., discharge, admission) is entered by the emergency physician. A disposition decision is operationally defined as the precise moment the attending emergency physician determines that active emergency care is complete. This includes the decision to transfer the patient to a hospital ward (for admissions) or the conclusion of clinical management (for discharges), even if the patient remains in the emergency department awaiting purely logistical arrangements, such as medical transport or family arrival. The measurement tool used to assess and timestamp this outcome is a standardized digital disposition decision tag integrated into the electronic health record.
Time From Treatment Room Placement to Disposition Decision
The time interval, measured in minutes, elapsed from when the patient is placed in an ED treatment room to the exact moment a definitive disposition decision (e.g., discharge, admission) is entered by the emergency physician. A disposition decision is operationally defined as the precise moment the attending emergency physician determines that active emergency care is complete. This includes the decision to transfer the patient to a hospital ward (for admissions) or the conclusion of clinical management (for discharges), even if the patient remains in the emergency department awaiting purely logistical arrangements, such as medical transport or family arrival. The measurement tool used to assess and timestamp this outcome is a standardized digital disposition decision tag integrated into the electronic health record.
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Hôpital Fribourgeois
Lead sponsor
University of Fribourg
Collaborator
