Applied Health Economics and Health Policy

, Volume 15, Issue 6, pp 795–803 | Cite as

Robustness and Effectiveness of the Triage System in the Pediatric Context

  • Marcello Montefiori
  • Enrico di Bella
  • Lucia Leporatti
  • Paolo Petralia
Original Research Article



The increasing use of emergency departments (EDs) potentially compromises their effectiveness and quality. The evaluation of the performance of the triage code system in a pediatric context is important because waiting time affects the quality of care for acutely ill patients.


In this study, we aimed to assess the effectiveness and robustness of the triage code system in a pediatric context and identify the determinants of waiting times for urgent and non-urgent patients.


Data regarding 37,767 pediatric patients who accessed the ED of a major Italian pediatric hospital in 2015 were investigated in order to study patient numbers and waiting times. The determinants of waiting times for urgent and non-urgent patients, as well as variables referring to the “supply side,” such as periods of staff shortage, were analyzed using a survival analysis framework.


For urgent patients, the waiting time between triage and the first physician assessment is generally below the standard threshold of 15 min and this is not affected by the number of non-urgent patients waiting for care. Conversely, the waiting time for non-urgent patients is affected by ED flow, periods of staff shortage, and non-clinical variables (age and nationality).


Our results suggest that the triage level assignation system is effective in terms of safety for urgent patients. The current ED organization adequately fulfills its primary goal of providing healthcare for acutely ill patients.



The authors would like to thank E.O. Gaslini for his invaluable cooperation in providing the data.

Authors’ contributions

Although all authors contributed to the conception of the study, the design of the study, and writing of the manuscript, MM and PP can be identified as the guarantors for the overall content and interpretation of the results. EdB and LL are responsible for the data analysis. PP is the provider of the data used for the analysis.

Compliance with ethical standards


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors (Marcello Montefiori, Enrico di Bella, Lucia Leporatti, and Paolo Petralia) have no conflicts of interest to declare.

Ethical statement

The study was carried out as part of routine checks conducted in the ED of the hospital and so ethical approval was not required. As is the case with all studies conducted in the hospital environment, the management of the hospital approved the study protocol. The management is responsible for ensuring the ethical aspects of all hospital activities.

Informed consent

On entering the hospital, all patients sign an informed consent form regarding treatment in the hospital.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of EconomicsUniversity of GenoaGenoaItaly
  2. 2.Department of Political ScienceUniversity of GenoaGenoaItaly
  3. 3.IRCCS Istituto Giannina GasliniGenoaItaly

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