Medical Sociology of Emergency Department Triage Queue Position and Handover Omission in Kenyan Referral Hospitals: A Time-and-Motion Estimation of Shift-Change Exposure and Information Loss

Emergency department triage assigns patients a queue position that determines when they are seen, but shift-change handover may systematically omit information about patients who are still waiting. The framework treats handover as a sampling event: at each shift change, the outgoing nurse transmits a subset of the information held about each waiting patient, and the probability of omission depends on queue position, information complexity and the time available for handover. A replication-based evaluation of the before-after-control-impact estimator was conducted across 2000 design cells, with cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points, under a declared variance structure with between-cluster SD of 6.0, residual SD of 4.5 and intraclass correlation of 0.64. The design achieves 80% power at 5 percentage points with 52 clusters. The framework proposes that queue position operates as a structural determinant of information loss, and the design analysis indicates that credible evaluation of handover interventions requires cluster counts well above those typical of single-facility studies. The contribution is a conceptual mechanism linking triage position to handover omission and a design-based account of what evidence would be needed to test it.