Adult Triage in the Emergency Department: Introducing a Multi-Layer Triage System.

Emergency department (ED) triage is the cornerstone of ED operations. Many different triage systems have been proposed and implemented globally. To date, an ideal triage system has not yet been identified. As the burden on EDs rises, with overcrowding being recognized as a universal problem, ED triage needs to be restructured to address this reality. Extensive and critical literature research over the years has identified the strengths and weaknesses of current ED triage implementations. A novel multi-layer triage system was introduced and implemented in Greek Eds, combining the strengths of various triage and early warning systems and scores to minimize under-triage and the adverse downstream effects it creates on patient outcomes. Acknowledging that no triage system can be universally adapted in different settings, the structural concepts of this triage system address most of the triage problems currently reported in the literature.