Development and Evaluation of an Online Emergency Triage Program at Phu Ruea Hospital, Loei Province
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Abstract
Paper-based emergency triage in community hospitals is prone to incomplete documentation and variable severity classification.
The objective to develop an online emergency triage program based on the Ministry of Public Health (MOPH) ED Triage five-level criteria and to evaluate its accuracy, data completeness, triage time and user satisfaction at a 30-bed community hospital in Loei Province, Thailand.
Methods: A four-phase research and development (R&D) study was conducted from 10 December 2025 to 25 July 2026 (ethics approval ECLOEI No. 031/2569, 9 December 2025). Evaluation used a separate-sample pre–post quasi-experimental design without a concurrent control group: 300 baseline paper-based encounters, 354 patients systematically sampled from 1,617 patients triaged with the program over three months, and 12 emergency nurses who rated satisfaction. Two blinded emergency physicians provided the reference standard. Proportions are reported with Wilson 95% confidence intervals (CI); completeness was compared item by item with Holm-adjusted tests, and triage time with Welch’s t-test.
The web application had six modules (expert-rated quality M = 4.49, SD = 0.42). Five-level agreement with the reference standard was 87.57% (310/354; 95% CI 83.73–90.61); all discordant cases differed by one level (under-triage 5.37%, over-triage 7.06%), and linearly weighted kappa was 0.88 (95% CI 0.85–0.92). For levels 1–2 versus 3–5, sensitivity was 95.0% (38/40; 95% CI 83.5–98.6), specificity 99.0% (311/314; 97.2–99.7), and under-triage among reference-standard emergent patients was 5.0% (1.4–16.5). Records with all seven items complete rose from 4.0% to 83.6%, and mean item completeness from 68.4% to 97.3% (p < 0.001 for every item). Mean triage time decreased from 6.64 to 4.37 minutes (difference 2.27 minutes, 95% CI 2.02–2.53; Cohen’s d = 1.42). Nurse satisfaction was high (M = 4.48).
Use of the program was associated with more complete records, shorter recorded triage time and high agreement with a physician reference standard. The under-triage estimate is imprecise, baseline accuracy was not measured, and time was measured differently before and after implementation; causal inference is therefore limited, and multi-site validation is needed.
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