International Emergency Nursing (2010) 18, 36–40 

Patient experience of the triage encounter in a Swedish 

emergency department 
Katarina E. Göransson RN, PhD (Nurse Manager of Research) a,b,c, 
*, 
Anette von Rosen MD, PhD (Associate Professor) a,c 
a Department of Emergency Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden b Department of 
Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden c Department of Medicine Solna, 
Karolinska Institutet, 171 76 Stockholm, Sweden 
Received 7 July 2009; received in revised form 29 September 2009; accepted 3 October 2009 
KEYWORDS Emergency department; Nurse; Patient experience; Triage 
Abstract Emergency department triage is a prerequisite for the rapid identification of criti- cally ill patients and for allocation of 
the correct acuity level which is pivotal for medical safety. The patient’s first encounter with a medical professional in the 
emergency department is often with the triage nurse. Objectives: To identify patient experience of the triage encounter. Methods: 
A questionnaire focusing on the patient–triage nurse relationship in terms of satis- faction with the medical and administrative 
information, privacy and confidentiality in the tri- age area as well as triage nurse competence and attitude was answered by 146 
participating patients. Results: The majority of patients perceived that while they were triaged immediately upon arrival to the 
emergency department, they were often given limited information about the waiting time. Although almost a quarter of the 
patients did not wish to have information about their medical condition from the triage nurse, 97% of the patients considered the 
triage nurse to be medically competent for the triage task. Conclusions: Patients were generally satisfied with the reception and 
care given by the triage nurses, but less satisfied about information about expected waiting time. We suggest therefore, that 
patients should be routinely informed about their estimated waiting time to be seen by the doctor in addition to their triage level. 
© 2009 Elsevier Ltd. All rights reserved. 
* 
Corresponding author. Address: Department of Emergency Med- 
Introduction icine, Karolinska University Hospital Solna, 
171 76 Stockholm, Sweden. Tel.: +46 8 517 702 60; fax: +46 8 517 711 11. 
E-mail addresses: katarina.goransson@karolinska.se (K.E. Gör- ansson), anette.vonrosen@karolinska.se (A. von Rosen). 
Emergency department (ED) triage is widely used in the western world (Fernandes et al., 2005). During the last 
1755-599X/$ - see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.ienj.2009.10.001 
available at www.sciencedirect.com 
journal homepage: www.elsevierhealth.com/journals/aaen 
 
decades,  research  on  ED  triage  has  focused  more  on  the  development  of  triage  scales  (Australasian  College  for  Emergency 
Medicine,  2000a;  Gilboy  et  al., 2003; Manchester Triage Group, 2006; Bullard et al., 2008) and less on patient perspective of the 
triage process (Topacoglu et al., 2004). 

Background 
Since  the  development  of  the  Australasian  Triage  Scale  in  the  1990s  (Australasian  College  for  Emergency  Medicine,  2000b), 
three  other  major  scales  have  been  introduced  worldwide  (Gilboy  et  al.,  2003;  Manchester  Triage  Group,  2006;  Bullard  et  al., 
2008).  Only  the  Manchester  Triage  Sys-  tem  (Manchester  Triage  Group,  2006)  has  evolved  based  on  the needs of an European 
emergency unit. 
In  addition  to  these  scales,  local  triage  scales  have  been  developed  in  several  European  countries.  Within  the  Euro-  pean 
Union  (EU),  a  variety  of  both  European  (Göransson  et  al.,  2005;  Rutschmann  et  al.,  2006;  Parenti  et  al.,  2009;  Taboulet  et al., 
2009)  and  non-European  scales  are  in  use  (van  Gerven  et  al.,  2001,  Jiménes  et  al.,  2003,  Elsh-  ove-Bolk  et  al.,  2007;  van  der 
Wulp  et  al.,  2008).  Moreover,  no  country  in  the EU has as yet implemented a mandatory triage scale (Elshove-Bolk et al., 2007) 
in contrast to e.g. Australia and Canada. 
New  triage  scales  are  continuously  being  developed  and  tested,  mostly  within  the  Western  world  (Maningas  et  al.,  2006; 
Rutschmann  et  al.,  2006;  Stockholm  County,  2007;  Parenti  et  al.,  2009;  Taboulet  et  al.,  2009;  Widgren  and  Jou-  rak,  in  press) 
with South Africa (Gottschalk et al., 2006) as a notable exception. 
Many  of  these  newer  scales  use  vital  signs  (respiratory  rate,  oxygen  saturation  and  heart  rate) with defined cut off levels for 
each  parameter  for  assessing  the  acuity  level  and  allocation  to  the  proper  triage  category.  Several studies of reproducibility and 
validity  of  the  various  triage  scales  have  been  published  (Considine  et  al.,  2000;  Dong  et  al.,  2006;  van  der  Wulp et al., 2008). 
The  American  College  of  Emergency  Physicians  and  the  Emergency  Nurses  Associa-  tion  recommend  that  EDs  in  the  US 
implement  either  the  Canadian  Triage  and  Acuity  Scale  (CTAS)  or  the  Emergency  Severity  Index  (ESI),  based  on  a  review  of 
available evidence (Fernandes et al., 2005). 
The  triage  assessment,  irrespective  of  which  triage  scale  is  being  used,  is  often  conducted  in  one  or  two  steps.  In  a one-tier 
system,  triage  is  carried  out  by  one  triage  nurse  while  in  a  two-tier  system,  it  is  performed in two steps by two triage nurses. In 
addition,  the  amount  of  actions  taken  during  triage  range  from  a  simple  visual  assessment  (spot  check)  to  a  more  thorough 
assessment where vital signs may be taken (comprehensive triage) (Gerber Zimmerman and McNair, 2006, Göransson, 2006). 
The  research on ED triage during the past decades has fo- cused mainly on the effectiveness and safety of different scales, and 
only  to  a  lesser  extent  on  the  perspective  of  the  patients  and  the  role  of  the  triage  nurse  (Raper  et  al.,  1999;  Elder  et  al., 2004; 
Topacoglu  et  al.,  2004;  Chan  and  Chau,  2005;  Dello  Stritto,  2005; Göransson et al., 2008). One study (Raper et al., 1999) found 
that  patients  were  less  satisfied  both  with  the  medical knowledge of the triage nurse and his/her ability to explain the procedures 
and show 
Patient experience of the triage encounter in a Swedish emergency department 37 
concern  for  the  patient  while  in  another  study  (Chan  and  Chau,  2005)  the  patients  were  generally  satisfied  with  the  caring  and 
teaching aspects of care received from the triage nurse. 
Studies  of  the  entire  ED  visit,  i.e.  not  confined  to  triage  as  such,  indicate  that  information  about  medical procedures and, in 
particular,  about  expected  waiting  time,  are  prereq-  uisites  for  patient  satisfaction  (Björvell  and  Stieg,  1991;  Thompson  et  al., 
1996;  Watt  et  al.,  2005).  Other  important  factors  for  patient  satisfaction  are  nurse  –  patient  commu-  nication,  the  physical 
environment  in  the  ED  and  the behav- iour and attitude of other members of the staff (Bruce et al., 1998; Boudreaux et al., 2004; 
Boudreaux and O’Hea, 2004; Topacoglu et al., 2004; Watt et al., 2005). 
Those  few  studies  investigating  patient  satisfaction  with  general  ED  care  as  well  as  triage  specific  care  have  mainly  been 
conducted  outside  the  EU.  Considering  the  paucity  of  European  studies  on  the  topic,  (Topacoglu  et  al.,  2004;  Pi-  trou  et  al., 
2009),  we  wished  to  study  patient  experience  of the triage encounter in a Swedish context. Swedish EDs are divided into several 
areas,  based  on  medical  speciali-  ties,  and  not,  as  in many Anglo-Saxon countries, based on triage level. Most EDs treat patients 
with  medical  and  surgi-  cal  problems,  and  patients  may  arrive  by  ambulance or pri- vate means. The EDs are open for everyone 
and  a  referral  letter  is  normally  not  required.  The  encounter  with the tri- age nurse is for many patients their first encounter with 
the ED and the impression the nurse gives is therefore likely to influence the patient’s experience of the ED visit. 
Methods 
Design 
This was a descriptive and observational cross-sectional sin- gle site study. 
Participants and setting 
The  Karolinska  University  Hospital  in  Solna  is  a  level  one  trauma  centre.  The  ED  treats  approximately  70,000  adult  patients 
presenting  with  non-psychiatric  complaints  annu-  ally.  A  two-tier  triage  system  is  used  that  includes  spot  check  and 
comprehensive  triage.  The  triage  decisions  are  based  on  a  five  level  triage  scale  called  Adaptive  Process  Triage  (ADAPT) 
developed at the Sahlgrenska University Hospital in Gothenburg, Sweden (Stockholm County, 2007) (Table 1). 
The  present  study  population  comprised  adults  seeking  care  at  the  ED  at  the  Karolinska  University  Hospital  Solna.  The 
sample  was a convenience sample of patients arriving by own means or ambulance and who registered at the ED during three day 
shifts  (8  am–4  pm)  and  three  evening  shifts  (4  pm–2  am)  during  a  two  week  period  in  March 2008. Inclu- sion criteria were as 
follows:  18  years  of  age  or  above,  tri-  age  level  3–5  according  to  ADAPT  (i.e.  not  severely  ill  or  injured  but  to  be  seen  by  a 
doctor within 120 min), Swedish speaking and finally, with no alteration of mental status. 
An  assistant  nurse  who  normally  worked  in  the  ED  but  who  at  the  time  of the study, did not take part in the clinical work in 
the ED, included patients by reading the patients’ 
 
triage  notes  in order to assess if the patients fulfilled the inclusion criteria. Those patients who fulfilled the inclusion criteria were 
then  approached,  and  an  assessment  of  the  patients’  physical  and  emotional  status  was  made.  Patients  considered  suitable  for 
participation  were  then  informed  about  the  project.  Consent  was  given  orally.  Patients  were  approached  adjacent  to  the  triage 
encounter,  while  they  were  waiting  for  medical  treatment  in  the  waiting  room  or  in  cubicles.  Clinicians,  including  the  triage 
nurse,  did  not  in-  clude  patients  or  administer  the  study  questionnaire.  The  assistant  nurse  handed  out  the  questionnaire  and 
collected  it  when the patient or his/her accompanying person had filled it out. When needed, the assistant nurse helped the patient 
fill out the questionnaire. 
Instrument 
The  questionnaire  was  developed  by  the  authors  for  a  previ-  ous  study  in  2007  and  was  tested  on  202  patients  (unpub-  lished 
data).  No  alterations  of  the questionnaire were made between the two data collection periods. The ques- tionnaire was based on a 
pre-existing  Swedish  questionnaire  which  had  been  employed  in  a  previous  investigation  of  pa-  tient  satisfaction  with  ED, 
adapted  to  the  triage  encounter  process.  The  modified  questionnaire  in  Swedish  comprised 23 questions; basic patient data such 
as  age,  sex,  language  and  if  with company or alone (4 questions), the experience of length of and information about waiting time 
(3  ques-  tions),  information  about  their  medical  condition  (2  ques-  tions),  information  about  the  triage  system  (4  questions), 
respect  of  privacy  in  the  triage  area  (1  question),  perceived  competence  of  the triage nurse (3 questions), reception by the triage 
nurse  (6 questions). Ten of the questions were de- signed with dichotomous answers (yes/no), 12 questions with multiple answers 
(very  good/good/moderate/bad)  and  one  open  question  (age).  No  patient  data  were  gathered  from  the  electronic  patient  record. 
The questionnaires were answered anonymously. 
Analysis 
Descriptive methods were used for data analysis. 
Ethical permission 
The ethics committee waived the need for approval as the study was considered a quality improvement project. Verbal 
38 K.E. Göransson, A. von Rosen 
Table 1 Time objectives associated with the triage levels of the Adaptive Process Triage. 
Triage levels Time to doctor 
Red Immediately Orange Within 15 min Yellow Within 120 mina Green Within 120 mina Blue Within 120 mina 
a Patients with yellow, green and blue triage levels are seen in order of arrival time and not by level of acuity. 
informed  consent  was  obtained  from  the  patients.  Patients  were  informed  of  the  voluntary  nature  of the study, and their right to 
refuse  or  to  withdraw  at  any  time  was  empha-  sized.  It  was  also  stressed  that  their  care  would  not  be  influ-  enced  by  their 
decision to take part or not in the study. The medical director of the ED approved the study. 

Results 
Demographic information 
A  total  of  695  patients  presented  at  the  ED  during  the  data collection period, of which 601 (87%) fulfilled the inclusion criteria. 
Of  the  eligible  patients,  165  (28%)  were invited to participate in the study, 146 (88%) agreed to participate, of which 83 (59.5%) 
patients  were  women.  Age  ranged  from 19 to 97, with a median age of 49.5 years. The majority, 117 (83%) were native Swedish 
speakers and just over half, 78 (53.1%) were accompanied by someone. 
Time issues in the ED 
In  total, 58.7% of the patients perceived that they were tri- aged immediately upon arrival to the ED. Of the remaining 41.3%, the 
waiting  time  to  triage  was  perceived  as  accept-  able  by  43.9%  of  the  patients  while  56.1%  felt  the  waiting  time  to  triage  was 
somewhat  or  much  too  long.  Only 30.9% of all the patients were given an estimate of the wait- ing time before being seen by the 
doctor, and only 22.4% of the participants were informed that the waiting time was dependent on their triage category. 
Medical condition and triage information 
A  total  of  23.9%  of  the  patients  did  not  request  any  informa-  tion  about  their  medical  condition  by  the triage nurse. Of the 105 
(76.1%)  patients  that whished to be informed, 56.5% considered the information adequate or partly ade- quate. Of the 94 (68.1%) 
patients  who  wanted  additional  information  from  the  triage  nurse,  90.3%  received  answers  that  were  clear  or  relatively  clear 
while one patient chose not to ask because of fear of disturbing the nurse. 
Triage nurse 
Nearly  all  (97.8%)  patients  felt  that  the  triage  nurses  were  competent  in  performing  triage,  while  slightly  fewer  (87.7%)  felt 
confidence  in  their  triage  nurse.  The  great  major-  ity  (94.8%)  of  the  patients  felt  that  the triage nurses fully or partly listened to 
them  and  that  their  complaints  were  taken  seriously.  While  36.8%  did  not  experience  a  need  to  talk  to  the  triage  nurse  about 
anxiety  regarding  their  condition,  85.7%  of  those  who  did have such a need, felt completely or partially that they were given the 
opportunity to do so. 
Of  the  two  thirds  (66.9%)  of  the  patients  who  needed  assistance  from the triage personnel at some stage during their waiting 
time,  94.4%  received  the  required  help.  A  total  of  96.3%  of  the  patients  felt  that  they  were  treated  with  re-  spect  and 
consideration, and 90.8% rated the reception by the triage nurse as very good or good. 
 
Privacy in the ED 
The majority (74.8%) of the patients felt that the respect for their personal integrity in the waiting room was good or very good. 

Discussion 
This  study  aimed  to  investigate  patient experience of ED tri- age. As many as 76% of the patients either underwent triage shortly 
after  their  arrival  in  the  ED  (n  =  84)  or  found  the  time  to  triage  acceptable  (n  =  25).  Since  any  kind  of  queue  for  tri-  age  is  a 
potential threat to the safety of the patients, time to triage ought to be kept to a minimum. 
Even  though  it  is  known  that  information  about  time  to  first  doctor  assessment  is  important for patient satisfaction (Björvell 
and  Stieg,  1991;  Bruce  et  al.,  1998;  Watt  et  al.,  2005),  this  information  was  given  to  less  than  one  third  of  the  patients  in  the 
current  study.  The  fact  that  even  fewer  patients  were  informed  about  the  relationship  between  their  triage category and waiting 
time  is  notable,  since  esti-  mated  waiting  time  has  been  found  to  be  more  important  than  actual  waiting  time  for  patient 
satisfaction  (Boudreaux  and  O’Hea, 2004). The percentage of patients in the present study asking for, but not receiving, adequate 
information was high, which may influence the overall impression of the visit to the ED in this hospital. 
Previous  research  has  shown  that  many  patients  seeking care at the ED are seriously concerned about their medical condition 
(Watt  et  al.,  2005).  It  was  therefore  an  unex-  pected  result  that  almost  a  quarter  (23.9%)  of  the  patients  did  not  ask  for 
information  about  their  medical  condition  from  the  triage  nurse.  One  explanation  might  be  that the patients preferred to discuss 
such  questions  with  the  doc-  tor.  Another  study  (Boudreaux  et  al.,  2000)  found  that  an  important  variable  for  overall  patient 
satisfaction with the ED visit was that the patient felt cared for. 
We found that nearly all (97.8%) patients regarded the tri- age nurse as fully or adequately competent for his/her task which is in 
agreement with a study by Raper et al. (1999). In this study a significant relationship between patient satis- faction and nurses’ 
level of education was found, indicating that patients were more satisfied with nurses having higher academic education. We did 
not collect data on the triage nurses in the current study, and hence, cannot make a sim- ilar analysis. The high proportion of 
patients (96.3%) re- ported being treated with respect and consideration is also in agreement with previous findings (Bruce et al., 
1998). The high percentage of patients (90.8%) that rated the qual- ity of the reception by the triage nurse as very good or good is 
concordant with a Turkish study (Topacoglu et al., 2004). This study has some limitations: (a) since the perception of the triage 
encounter was not investigated in seriously ill and injured patients, generalization to that cohort can not be done; (b) patients 
completed the questionnaire during their ED visit before their first medical assessment, this may have influenced the rating in a 
false positive way although the anonymous participation may have reduced the risk for such bias; (c) the collection of data during 
cer- tain hours of the day (8–2 am) and during one single month is a limitation with regards to representativity of the sam- 
Patient experience of the triage encounter in a Swedish emergency department 39 
ple.  However  only  a  limited  number  of  patients  arrive  during  night  and  early  hours  of  the  morning  (2–8  am) in our ED and we 
believe  that  these  results  can  be  applied  to  patients  attending  any  time  of  day.  Also,  the  month  when  data  col-  lection  was 
conducted is representative for the majority of the months in our ED. 
Since  the  study  investigated  how  ED  triage  was  experi-  enced  from  the  patient  perspective,  no  data  on  patients’  ac-  tual 
waiting  time  and  triage  levels  were  collected.  Collection  of  qualitative  data,  for  example  through open ended ques- tions, could 
have  generated  additional interesting and impor- tant information. Finally, even though our study had a high response rate (88%), 
the  participation  rate  of  24%  is  a  limita-  tion,  and  needs  to  be taken into account when generalizing the results. Even though we 
had  a  data  collector  employed  for  including  patients  and  collecting  data,  slightly  less  than  a  quarter  of  eligible  patients 
participated.  One  explanation  for  the  low  participation  rate  may  be  that  patients are being moved around in the ED and between 
other  units  such  as  X-  ray, making it difficult to keep track of them, and hence, ask them to participate. Another explanation may 
be  that  the  data  collector,  when  approaching  a  possible  participant, rapidly noticed when a patient was not suitable for participa- 
tion, e.g. due to distress, and refrained from, asking. 

Conclusions 
This  study  presents  new  information  about  patient  satisfac-  tion  with  ED  triage  from  a  Swedish  perspective.  Patients  were 
generally  satisfied  with  the reception and care given by the triage nurses. However, one important factor needs to be addressed in 
the  ED,  namely  the  fact  that  information  about  the  expected  waiting  time  was  only  communicated  to a restricted amount of the 
patients.  One suggestion is to routinely inform patients about their triage level, and their estimated waiting time before being seen 
by the doctor. 

Role of funding sources 

There  are  no  financial  conflicts of interest in the current study. KG is a member of the national work group of ADAPT. Financial 
support for this study was given by the Department of Emergency Medicine, Karolinska University Hospital Solna. 

Acknowledgements 
We  would  like  to  thank  Ankie  Eriksson, Elin Magnusson and Tamara Barlow, all at the Department of Emergency Medi- cine at 
Karolinska  University  Hospital  Solna  for  collecting  data,  providing  electronic  patient  record  data  and  language  revision 
respectively.  Further,  we  wish  to  thank  the  Depart-  ment  of  Emergency  Medicine  at  Karolinska  University Hospi- tal Solna for 
providing financial support for this study. 

References 
Australasian  College  for Emergency Medicine, 2000a. Guidelines on the implementation of the Australasian triage scale in emer- 
gency  departments.  <http://www.acem.org.au/media/poli-  cies_and_guidelines/G24_Implementation__ATS.pdf>  (accessed 
29.03.07). 
 
Australasian College for Emergency Medicine, 2000b. Policy on the Australasian Triage Scale. <http://www.acem.org.au/media/ 
policies_and_guidelines/P06_Aust_Triage_Scale_-_Nov_2000.pdf> (accessed 24.05.07). Björvell, H., Stieg, J., 1991. Patients’ 
perceptions of the health care received in an emergency department. Annals of Emer- gency Medicine 20, 734–738. Boudreaux, 
E., Ary, R., Mandry, C., McCabe, B., 2000. Determinants of patient satisfaction in a large, municipal ED: the role of 
demographic variables, visit characteristics, and patient per- ceptions. American Journal of Emergency Medicine 18, 394–400. 
Boudreaux, E., D’Autremont, S., Wood, K., Jones, G., 2004. Predictors of emergency department patient satisfaction: sta- bility 
over 17 months. Academic Emergency Medicine 11, 51–58. Boudreaux, E., O’Hea, E., 2004. Patient satisfaction in the emer- 
gency department: a review of the literature and implications for practice. The Journal of Emergency Medicine 26, 13–26. Bruce, 
T., Bowman, J., Brown, S., 1998. Factors that influence patient satisfaction in the emergency department. Journal of Nursing 
Care Quality 13, 31–37. Bullard, M., Unger, B., Grafstein, E., The CTAS National Working Group, 2008. Revisions to the 
Canadian emergency department triage and acuity scale (CTAS) adult guidelines. Canadian Journal of Emergency Medicine 10, 
136–142. Chan, J., Chau, J., 2005. Patient satisfaction with triage nursing 
care in Hong Kong. Journal of Advanced Nursing 50, 498–507. Considine, J., Ung, L., Thomas, S., 2000. Triage nurses’ 
decisions using the national triage scale for Australian emergency departments. Accident and Emergency Nursing 8, 201–209. 
Dello Stritto, R., 2005. The Experiences of the Emergency Triage Nurse: A Phenomenological Study. College of Nursing, Texas 
Woman’s University, Denton. Dong, S., Bullard, M., Meurer, D., Blitz, S., Ohinmaa, A., Holroyd, B., Rowe, B., 2006. Reliability 
of computerized emergency triage. Academic Emergency Medicine 13, 269–275. Elder, R., Neal, C., Davis, B., Almes, E., 
Whitledge, L., Littlepage, N., 2004. Patient satisfaction with triage nursing in a rural hospital emergency department. Journal of 
Nursing Care Quality 19, 263–268. Elshove-Bolk, J., Mencl, F., van Rijswijck, B., Simons, M., van Vugt, A., 2007. Validation of 
the emergency severity index (ESI) in self-referred patients in a European emergency department. Emergency Medicine Journal 
24, 107–174. Fernandes, C., Tanabe, P., Gilboy, N., Johnson, L., McNair, R., Rosenau, A., Sawchuk, P., Thompson, D., Travers, 
D., Bonalumi, N., Suter, R., 2005. Five-level triage: a report from the ACEP/ENA five- level triage task force. Journal of 
Emergency Nursing 31, 39–50. Gerber Zimmerman, P., McNair, R., 2006. Triage Nursing Secrets. In: Gerber Zimmerman, P., 
Herr, R. (Eds.), Triage essence and process in Triage nursing secrets. Mosby, Inc, Missouri. Gilboy, N., Tanabe, P., Travers, D., 
Eitel, D., Wuerz, R., 2003. The Emergency Severity Index. Emergency Nurses Association, Des Plaines. Gottschalk, S., Wood, 
D., DeVries, L., Bruijns, S., 2006. The cape triage score: a new triage system South Africa. Emergency Medicine Journal, 
149–153. Göransson, K., 2006. Registered Nurse-Led Emergency Department triage: Organisation, Allocation of Acuity Ratings 
and Triage Decision Making. Department of Caring Sciences, O ̈rebro Uni- versity, O ̈rebro. Göransson, K., Ehnfors, M., 
Fonteyn, M., Ehrenberg, A., 2008. Thinking strategies used by registered nurses during emergency 
40 K.E. Göransson, A. von Rosen 
department triage. Journal of Advanced Nursing 61, 163– 172. Göransson, K., Ehrenberg, A., Ehnfors, M., 2005. Triage in emer- 
gency departments: national survey. Journal of Clinical Nursing 14, 1067–1074. Jiménes, J., Murray, M., Beveridge, R., Pons, J., 
Cortés, A., Garrigós, J., Ferré, M., 2003. Implementation of the Canadian Emergency Department Triage and Acuity Scale 
(CTAS) in the Principality of Andorra: Can triage parameters serve as emer- gency department quality indicators? Canadian 
Journal of Emergency Medicine 5, 315–322. Manchester Triage Group, 2006. Emergency Triage. Blackwell 
Publishing Inc., Haryana. Maningas, P., Hime, D., Parker, D., McMurry, T., 2006. The soterion rapid triage system: 
evaluation of inter-rater reliability and validity. The Journal of Emergency Medicine 30, 461–469. Parenti, N., Ferrara, L., 
Reggiani, M., Sangiorgi, D., Lenzi, T., 2009. Reliability and validity of two four-level emergency triage scales. European Journal 
of Emergency Medicine 16, 115–120. Pitrou, I., Lecourt, A.-C., Bailly, L., Brousse, B., Dauchet, L., Ladner, J., 2009. Waiting 
time and assessment of patient satisfaction in a large reference emergency department: a prospective cohort study, France. 
European Journal of Emer- gency Medicine 16, 177–182. Raper, J., Davis, B., Scott, L., 1999. Patient satisfaction with 
emergency department triage nursing care: a multicenter study. Journal of Nursing Care Quality 13, 11–24. Rutschmann, O., 
Kossovsky, M., Geissbuhler, A., Perneger, T., Vermeulen, B., Simon, J., Sarasin, F., 2006. Interactive triage simulator revealed 
important variability in both process and outcome of emergency triage. Journal of Clinical Epidemiology 59, 615–621. 
Stockholm County, 2007. Triagearbete på akutmottagning. <http:// www.webbhotell.sll.se/PageFiles/3126/FR_Triage.pdf> 
(accessed 9.06.08) [in Swedish]. Taboulet, P., Moreira, V., Haas, L., Porcher, R., Braganca, A., Fontaine, J.-P., Poncet, M.-C., 
2009. Triage with the French emergency nurses classification in hospital scale: reliability and validity. European Journal of 
Emergency Medicine 16, 61–67. Thompson, D., Yarnold, P., Wiliams, D., Adams, S., 1996. Effects of actual waiting time, 
perceived waiting time, information deliv- ery, and expressive quality on patient satisfaction in the emer- gency department. 
Annals of Emergency Medicine 28, 657–665. Topacoglu, H., Karcioglu, O., Ozucelik, N., Ozsarac, M., Degerli, V., Sarikaya, S., 
Cimrin, A., Soysal, S., 2004. Analysis of factors affecting satisfaction in the emergency department: a survey of 1019 patients. 
Advances in Therapy 21, 380–388. van der Wulp, I., van Baar, M., Schrijvers, A., 2008. Reliability and validity of the 
Manchester triage system in a general emergency department patient population in the Netherlands: results of a simulation study. 
Emergency Medicine Journal 25, 431–434. van Gerven, R., Delooz, H., Sermeus, W., 2001. Systematic triage in the emergency 
department using the Australian National Triage Scale: a pilot project. European Journal of Emergency Medicine 8, 3–7. Watt, 
D., Wertzler, W., Brannan, G., 2005. Patient expectations of emergency department care: phase I – a focus group study. Canadian 
Journal of Emergency Medicine 7, 12–16. Widgren, B., Jourak, M., in press. Medical emergency triage and treatment system 
(METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. The Journal of Emergency 
Medicine.