Barriers and facilitators to implementing a new emergency department triage strategy that promotes patient engagement

Background Acute respiratory and gastrointestinal infections account for a significant portion of visits to North American emergency departments (EDs). Local problem To manage growing patient volumes and wait times, a new ED triage strategy was introduced using rapid, near-patient diagnostic tests and a patient self-administered risk stratification tool. The aim of this article is to identify barriers and enabling conditions of the implementation of this new strategy, with a focus on its patient self-risk stratification tool. Methods A qualitative study was conducted from March 2020 to November 2022 across two EDs in different cities. Researchers carried out semi-structured interviews and in situ observations with healthcare workers (HCWs) and patients. Interventions Participants were informed about the diagnostic tools and risk stratification process, then asked to identify potential barriers and enabling factors. Results Interviews were conducted with 22 HCWs and 14 patients. Barriers to using the self-assessment tool included psychological, social, organizational, and cultural issues, especially negative perceptions of using the tool after arriving at the ED. Suggestions for improvement included promoting tool use before ED visits, integrating appointment links, clarifying medicolegal aspects, providing online access, and including self-care guidance. Conclusion Although the new triage strategy poses implementation challenges, HCWs believed using the self-risk stratification tool before ED visits could help redirect mildly ill patients to more appropriate healthcare settings.