Improving the Accuracy of ED Triage Using the Australasian Triage Scale: A Closed-Loop Quality Improvement Project

Background and aim Accurate ED triage is essential for patient safety, timely care, and effective resource utilization. The Australasian Triage Scale (ATS) provides a standardized framework for prioritizing patients based on clinical urgency; however, variability in its application may compromise care quality. This clinical audit aimed to assess compliance with the ATS in an ED and to evaluate the impact of targeted quality improvement interventions on triage accuracy. Methods A prospective closed-loop clinical audit was conducted in the ED of 6 October Hospital, Dokki. A total of 868 triage encounters were reviewed across two audit cycles (434 cases per cycle). Baseline data were collected between October 1 and 15, 2025, followed by a three-week intervention consisting of structured education, bedside coaching, and cognitive support tools. Reaudit data were collected between November 8 and 22, 2025. The primary outcome was the proportion of correctly assigned ATS categories, and differences between cycles were analyzed using the chi-square test. Results At baseline, correct ATS category assignment was documented in 320 of 434 cases (73.8%), below the predefined audit standard of ≥90%. Following the intervention, correct triage assignment increased to 393 of 434 cases (90.6%), meeting the audit standard. This improvement in triage accuracy was statistically significant (χ² test, p < 0.001). Conclusions This audit demonstrated that targeted educational and system-based interventions significantly improved compliance with the ATS. The findings highlight the effectiveness of structured training, bedside coaching, and cognitive support tools in enhancing triage accuracy in high-volume emergency departments. Improved triage performance has important implications for patient safety, timely clinical decision-making, and optimal resource utilization. A closed-loop clinical audit represents a practical and sustainable approach for monitoring and improving triage practices, and similar strategies may be applied in other emergency care settings to strengthen the quality and consistency of care.