The impact of optimizing the triage process for cardiac patients presenting to the cardiac emergency department on quality of care indicators: a quasi-experimental study in Southern Iran

Ischemic heart disease (IHD) is the leading cause of global mortality and a major contributor to healthcare costs. Effective assessment and management in emergency departments (EDs) remain challenging. This study examined the impact of optimizing the triage process for cardiac ischemia patients on quality-of-care indicators. In this quasi-experimental pretest–posttest study, twenty nurses were recruited through census sampling. The intervention consisted of a structured, scenario-based triage educational program based on the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, combined with face-to-face on-site training, conducted over a three-week period with minor modifications to the triage unit, equipment upgrades, and reinforcement of triage staffing. Prior to the intervention, nurses’ triage performance was evaluated during the triage of 200 cardiac patients. Outcome measures included key care time indicators, patient satisfaction, and nurse performance in the triage of cardiac patients. Following completion of the intervention, outcomes in the triage of 200 cardiac patients were re-evaluated by the researcher. Nurse performance (58.67%) and its subscale scores, including triage management (38.7%), risk assessment (40.5%), patient assessment (57.1%), symptom assessment (51.2%), pain management (197.4%), adherence to the ACC/AHA guidelines (41.99%), and overall triage performance score (58.67%), improved significantly, along with patient satisfaction (5.45%). Door-to-pain (50%), door-to-ECG (55%), and arrival-to-triage completion (40.4%) times also showed significant improvement, although triage duration (28.5%) increased. No significant change was observed in the waiting time from triage completion to physician visit. Cardiac-specific triage training enhances nurse performance, patient satisfaction, and reduces key care intervals; however, it increased time spent and triage and did not reduce waiting time to physician visit. Further research is needed to streamline the triage process and evaluate the long-term impact of such interventions on clinical outcomes.