title: Implementation of a Pediatric Emergency Triage System in Xiamen, China.
abstract: BACKGROUND
  Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale.
  
  
  METHODS
  In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system. Patients who visited our PER before (January 2013-June 2013) and after (January 2014-June 2014) the CPETS was implemented served as the control and experimental group, respectively. Patient flow, triage rates, triage accuracy, wait times (overall and for severe patients), and patient/family satisfaction were compared between the two groups.
  
  
  RESULTS
  Relative to the performance of the former system experienced by the control group, the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test, t = 0, P < 0.05), a higher triage rate (93.40% vs. 90.75%; χ2 = 801.546, P < 0.001), better triage accuracy (96.32% vs. 85.09%; χ2 = 710.904, P < 0.001), shorter overall wait times (37.30 ± 13.80 min vs. 41.60 ± 15.40 min; t = 11.27, P < 0.001), markedly shorter wait times for severe patients (2.07 [0.65, 4.11] min vs. 3.23 [1.90,4.36] min; z = -2.057, P = 0.040), and higher family satisfaction rates (94.23% vs. 92.21%; χ2 = 321.528, P < 0.001).
  
  
  CONCLUSIONS
  Implementing the CPETS improved nurses' abilities to triage severe patients and, thus, to deliver the urgent treatments more quickly. The system shunted nonurgent patients to outpatient care effectively, resulting in improved efficiency of PER health-care delivery.
authors.affiliation: Department of Pediatrics, Southern Medical University, Guangzhou, Guangdong 510515; Department of Pediatric Emergency Medicine, First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
authors.forename: Gang-Xi
authors.initials: GX
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
authors.forename: Yin-Ling
authors.initials: YL
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, Montreal Children's Hospital, Tupper V5L 2N1, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Kudirka
authors.affiliation: Department of Emergency Medicine, British-Columbia Children's Hospital, Vancouver, BC V5L 2N1, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Church
authors.affiliation: Department of Emergency Medicine, British-Columbia Children's Hospital, Vancouver, BC V5L 2N1, Canada.
authors.forename: Collin K K
authors.initials: CK
authors.lastname: Yong
authors.affiliation: Department of Emergency Medicine, Mater Children's Hospital, Paddington, Queensland 4101, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Reilly
authors.affiliation: Department of Pediatrics, Southern Medical University, Guangzhou, Guangdong 510515, China.
authors.forename: Qi-Yi
authors.initials: QY
authors.lastname: Zeng
mesh_terms: D002681:China; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010372:Pediatrics; D013997:Time Factors