The Indian Journal of Pediatrics

, Volume 85, Issue 10, pp 849–854 | Cite as

The Impact of Triage Nurse-ordered Diagnostic Studies on Pediatric Emergency Department Length of Stay

  • Youwei Li
  • Qunfeng LuEmail author
  • Hua Du
  • Jianping Zhang
  • Lingling Zhang
Original Article



To identify the need to revise the program triage nurse-ordered diagnostic tests in the emergency department (ED) of pediatric hospital, and to evaluate implementation of this program with three laboratory routine tests, namely blood, urine and stool, which the triage nurses ordered as relevant to pediatric patients’ symptoms.


The authors retrospectively reviewed the data of patients who registered in their ED between December 2015 and April 2016, including the tests as per the orders by triage nurses, and the time they arrived and the time they had their final payments. A comparison was made of those, who stayed in the ED, with nurse-requested tests, to those without such tests.


The review indicated the total number of subjects who presented in ED during the study period and were included in the study was 116,202; 65.4% with nurse-requested tests while 34.6% without such tests. On median, the length of their stay with nurse-requested tests was 229 min and without such tests was 244 min, which has significant difference (P = 0.000).


The results of this program were associated with a reduction in ED treatment which achieved the purpose to improve high patient flow in the emergency department. However, this intervention needs further studies to develop the nurse-ordered diagnostic studies program with more different clinical conditions and tests including triage nurses training and guideline.


Triage nurse-ordered diagnostic studies Emergency department Emergency care Overcrowding Pediatric Nursing 



The authors sincerely thank Hua Du, Jianping Zhang and Lingling Zhang, the chief nurse and two education nurses in the Emergency Department of Shanghai Children’s Hospital, for their assistance in data collection and guidance in using triage nurse-ordered diagnostic studies program at triage.


QL designed this study and will act as guarantor for this paper. YL participated in formulating the management methods and drafted the article. HD, JZ and LZ participated in training triage nurses to provide triage nurse-ordered diagnostic studies service and in collecting the data. All authors have read and approved this article.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding

The task was completed thanks to the supports from Nursing Management Program of Shanghai Municipal Commission of Health & Family Planning (No. 140822111537878).


  1. 1.
    Boyle A, Beniuk K, Higginson I, Atkinson P. Emergency department crowding: time for interventions and policy evaluations. Emerg Med Int. 2012;2012:838610.CrossRefGoogle Scholar
  2. 2.
    Oredsson S, Jonsson H, Rognes J, et al. A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian J Trauma, Resuscitation Emerg Med. 2011;19:43.CrossRefGoogle Scholar
  3. 3.
    Chen JD, Wang XZ, Li XM. The value of BR test and CRP test in advance in children's outpatient and emergency process optimization. Med Manag. 2014;31:37–9.Google Scholar
  4. 4.
    McHugh M, Van Dyke K, McClelland M, Moss D. Improving patient flow and reducing emergency department crowding: a guide for hospital. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290–200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; 2011.Google Scholar
  5. 5.
    Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–36.CrossRefGoogle Scholar
  6. 6.
    Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part 1- concept, causes, and moral consequences. Ann Emerg Med. 2009;53:605–11.CrossRefGoogle Scholar
  7. 7.
    Retezar R, Bessman E, Ding R, Zeger SL, McCarthy ML. The effect of triage diagnostic standing orders on emergency department treatment time. Ann Emerg Med. 2011;57:89–99.CrossRefGoogle Scholar
  8. 8.
    Rowe BH, Villa-Roel C, Guo X, et al. The role of triage nurse ordering on mitigating overcrowding in emergency department: a systematic review. Acad Emerg Med. 2011;18:1349–57.CrossRefGoogle Scholar
  9. 9.
    Ghanes K, Jouini O, Wargon M, Jemai Z. Modeling and analysis of triage nurse ordering in emergency departments. IEEE. Conference on Industrial Engineering and Systems Management IESM'15, Seville, Spain. 2015, <10.1109/IESM.2015.7380163>. <hal-01265284>.Google Scholar
  10. 10.
    Robinson DJ, Moore K. An integrative review: triage protocols and the effect on ED length of stay. J Emerg Nurs. 2013;39:398–408.CrossRefGoogle Scholar
  11. 11.
    Cheung WW, Heeney L, Pound JL. An advanced triage system. Accid Emerg Nurs. 2002;10:10–6.CrossRefGoogle Scholar
  12. 12.
    Lindley-Jones M, Finlayson B. Triage nurse requested x rays-are they worthwhile? Accid Emerg Med. 2000;17:103–7.CrossRefGoogle Scholar
  13. 13.
    Yoon P, Steiner I, Reinhardt G. Analysis of factors influencing length of stay in the emergency department. CJEM. 2003;5:155–61.CrossRefGoogle Scholar
  14. 14.
    Askenasi R, Lheureux PE, Gillet JB. Influence of tests on patient time in the emergency department. Reanimation Soins Intensifs Medecine d'Urgency. 1989;5:201–2.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Youwei Li
    • 1
  • Qunfeng Lu
    • 1
    Email author
  • Hua Du
    • 2
  • Jianping Zhang
    • 2
  • Lingling Zhang
    • 2
  1. 1.Nursing Department, Shanghai Children’s HospitalShanghai Jiaotong UniversityShanghaiChina
  2. 2.Emergency Department, Shanghai Children’s HospitalShanghai Jiaotong UniversityShanghaiChina

Personalised recommendations