Introduction

INTRODUCTION: BACKGROUND AND JUSTIFICATION

First of all, the word “triage” comes from the French word “trier”, which means “to sort”. It was originally applied by Dominique Jean Larrey, a surgeon in Napoleon’s Imperial Guard (Fig.1), who created a method that quickly evaluated and categorized the wounded in battle permitting the evacuation of those who required the most urgent medical attention. ^[1]

In the beginning of 1960, the Triage System was implemented in the Urgency Services (US) at the hospitals.^[2,3] (Fig.1)

Nowadays, there are different triage systems: The Canadian triage and acuity scale (CTAS), The Australasian triage scale (ATS) and The Manchester Triage System (MTS).^[2,3]

The MTS was created in Manchester (United Kingdom) in 1997. By this year the Health Ministry adopted the MTS as a tool to restore emergency departments.

The MTS exists in Portugal since 2000 and the two hospitals that first received it were: Hospital Geral de Santo António and Hospital Fernando Fonseca. ^[4] (Fig.1).

Nowadays the Manchester Triage System is the most widely used triage system in the Europe and Australia.

The aim of the Manchester Triage System is to determine the clinical priority of patients. Identifying their signs and symptoms, the nurse with a short assessment determines their urgency level (Fig.2). The most urgent patient will be seen more quickly than a non-urgent.

                There are five urgency categories differentiated by colours, with a maximum waiting time: ^[2,3]

·        Immediate - Red - 0 minutes;

·        Very Urgent - Orange - 10 minutes;

·        Urgent - Yellow - 60 minutes;

·        Standard - Green - 120 minutes;

·        Non-urgent - Blue - 240 minutes.

The need to adopt a triage system comes from the fact that every day, Emergency Departments get crowded of new cases. Without an appropriate system, in some cases there is a delay on the initiation of treatment which could turn into health problems or even to death. ^[5] Therefore it is necessary to implante systems that prioritise patients^[2,5]. Because of this, the MTS became an essential factor on Emergency Departments. The utilization of this triage system gives many advantages to an emergency including reference to an acceptable decision-making structure, as it enables an orientation of patients to an appropriate level of care. ^[6]

But, even after MTS being validated with good ranks on some studies, it must be always adjusted, kept on mutation and dynamism, by studying its sensitivity and specificity levels.  ^[7]

All around the world, studies about MTS and some specific subjects such as the mortality, triage errors and waiting times, have been done as same as simulation surveys. ^[2,5,8,9,10]

For example, in the Portuguese Hospital, Fernando Fonseca, in Lisbon, a survey was done to know if there was a possible association between the priority group and short-term mortality. The researchers concluded that there really is a close relationship turning MTS in a powerful tool. ^[5]

Another example is the survey made in Netherlands which tried to assess the reliability and validity of the Manchester Triage System (MTS) in a general emergency department. The results allowed the researchers to conclude that inter-ratter reliability is "moderate" to "substantial" and that under triage primarily occurs in the MTS categories orange and yellow. It was also concluded that the MTS is more sensitive for children who need immediate or urgent care than for any other patients. ^[8]

Moreover, another study has been done in Portugal, in Hospital Reynaldo dos Santos, about the influence of MTS in coronary syndromes. This research evaluates the good management of waiting times as a factor of efficiency in the treatment of this kind of diseases by recording the colour assigned in the Manchester triage, mean time from arrival in the Emergency Department to MTS, mean time from MTS to first medical assessment and mean time from it to admission. ^[11] This last study has similar methods to the one we develop. However, our study allow a more general view, instead of restricting it to a specific field like cardiology.