Introduction Hospital triage represents the first act of clinical assessment for the person accessing the Emergency Department and the main tool for regulating patient flow. The accuracy of priority code assignment is therefore a direct indicator of the quality and safety of the care provided. While underestimation (under-triage) exposes the patient to a potentially fatal delay in care, overestimation (over-triage) results in an improper consumption of high-intensity resources. Objective To evaluate the appropriateness of red-code assignment in nursing triage at the Macerata Emergency Department in 2025, quantifying the phenomenon of over-triage and identifying its determining factors. Materials and methods Following a literature review, a single-center retrospective observational study was conducted on accesses recorded at the Macerata Emergency Department from January 1 to December 31, 2025. Over-triage was defined as a red-code access followed by discharge home. The statistical tests employed were the chi-square test and a logistic regression model (R software, version 4.5.3). Results The review included six international studies, from which three key determinants of triage accuracy emerged. Red codes numbered 2,077 (5.07%). Neither the days of highest patient volume nor the triage nurse's experience were significantly associated with over-triage (p > 0.05); the presenting complaint, however, proved to be a significant determinant (p < 0.05), with the highest values for the categories "Allergy" (OR = 12.3) and "Trauma" (OR = 4.8). Conclusions The phenomenon of over-triage among red codes at the Macerata Emergency Department constitutes a cross-cutting critical issue, attributable neither to patient volume pressure nor to years of service, but rather to the nature of the presenting clinical picture. The evidence gathered points toward a multidimensional approach grounded in targeted training, systematic clinical audits on coding agreement, and patient outcomes.
Introduzione Il triage intraospedaliero rappresenta il primo atto di valutazione clinica della persona che accede al Pronto Soccorso e il principale strumento di regolazione dei flussi assistenziali. L'accuratezza dell'assegnazione del codice di priorità costituisce, pertanto, un indicatore diretto della qualità e della sicurezza delle cure erogate. Se la sottostima (under-triage) espone il paziente a un ritardo potenzialmente fatale nella presa in carico, la sovrastima (over-triage) comporta un consumo improprio di risorse ad alta intensità. Obiettivo Valutare l'appropriatezza dell'assegnazione del codice rosso al triage infermieristico del Pronto Soccorso di Macerata nell'anno 2025, quantificando il fenomeno dell'over-triage e identificandone i fattori determinanti. Materiali e metodi Previa revisione della letteratura è stato svolto uno studio osservazionale retrospettivo monocentrico sugli accessi registrati nel Pronto Soccorso di Macerata dal 1° gennaio al 31 dicembre 2025. L'over-triage è stato definito come accesso in codice rosso seguito da dimissione a domicilio. I test statistici impiegati sono test del chi-quadro e modello di regressione logistica (software R 4.5.3). Risultati La revisione ha incluso sei studi internazionali, dai quali sono emerse le tre aree determinanti dell'accuratezza del triage. I codici rossi sono risultati 2.077 (5,07%). Né i giorni di maggiore afflusso né l'esperienza del triagista si sono associati in misura statisticamente significativa all'over-triage (p > 0,05); il problema di presentazione è risultato invece un determinante significativo (p < 0,05), con valori massimi per le categorie "Allergia" (OR = 12,3) e "Traumatologico" (OR = 4,8). Conclusioni Il fenomeno dell'over-triage nei codici rossi del Pronto Soccorso di Macerata si configura come una criticità trasversale, non riconducibile né alla pressione di afflusso né all'anzianità di servizio, bensì alla natura del quadro clinico di presentazione. Le evidenze raccolte orientano verso un approccio multidimensionale fondato su formazione mirata, audit clinico sistematico di concordanza fra codifica ed esito.
Appropriatezza del codice rosso in Pronto Soccorso: analisi e strategie di miglioramento dell'over-triage al Pronto Soccorso di Macerata
FILIPPONI, SERENA
2025/2026
Abstract
Introduction Hospital triage represents the first act of clinical assessment for the person accessing the Emergency Department and the main tool for regulating patient flow. The accuracy of priority code assignment is therefore a direct indicator of the quality and safety of the care provided. While underestimation (under-triage) exposes the patient to a potentially fatal delay in care, overestimation (over-triage) results in an improper consumption of high-intensity resources. Objective To evaluate the appropriateness of red-code assignment in nursing triage at the Macerata Emergency Department in 2025, quantifying the phenomenon of over-triage and identifying its determining factors. Materials and methods Following a literature review, a single-center retrospective observational study was conducted on accesses recorded at the Macerata Emergency Department from January 1 to December 31, 2025. Over-triage was defined as a red-code access followed by discharge home. The statistical tests employed were the chi-square test and a logistic regression model (R software, version 4.5.3). Results The review included six international studies, from which three key determinants of triage accuracy emerged. Red codes numbered 2,077 (5.07%). Neither the days of highest patient volume nor the triage nurse's experience were significantly associated with over-triage (p > 0.05); the presenting complaint, however, proved to be a significant determinant (p < 0.05), with the highest values for the categories "Allergy" (OR = 12.3) and "Trauma" (OR = 4.8). Conclusions The phenomenon of over-triage among red codes at the Macerata Emergency Department constitutes a cross-cutting critical issue, attributable neither to patient volume pressure nor to years of service, but rather to the nature of the presenting clinical picture. The evidence gathered points toward a multidimensional approach grounded in targeted training, systematic clinical audits on coding agreement, and patient outcomes.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/28949