Triage system performance: consistency and accuracy in the emergency centre

Triage systems have evolved over recent times with the use of tiered acuity to achieve a balance between patient need and resource availability. Triage is a way to sort patients based on acuity, irrespective of the setting, and whether by telephone, in the prehospital environment or in hospital. The growth of the paramedic profession means that paramedics are now working in emergency centres and having to contend with the concept of triage in this setting. The nature of emergency centres and the variety of patient presentations makes it nearly impossible to have a perfect system that is both consistent and accurate. Paramedics, as decision makers, should understand the underlying concepts of what makes a triage system perform well so best practice can be adopted with specific goals in mind. There is a patient-centred focus to do the most for the most at any given time and to ensure that resources are aligned with the needs of patients. It is vital to monitor a triage system's performance so that improvements or adjustments can be made in response to patient population needs over time. This commentary focuses on the main principles of triage system performance measures and what factors should be taken into consideration during clinical practice. Highlighting the concepts of triage reliability, validity and decision-making should help paramedics to understand the importance of conscious decision-making practice.