Integration of the Emergency Severity Index (ESI) Triage System in the Outpatient Department of Thong Pha Phum Hospital: A Participatory Action Research Process in a Community Hospital

Abstract

     This study aimed to develop and evaluate the integration of the Emergency Severity Index (ESI) triage system in the outpatient department of Thong Pha Phum Hospital, Kanchanaburi Province. A participatory action research design with a mixed-methods approach was employed. The study was conducted over an eight-month period across three action research cycles in the outpatient department of Thong Pha Phum Hospital. Participants included 15 registered nurses, 7 relevant healthcare personnel, and 323 outpatient service users. Research instruments consisted of a knowledge test, skill observation form, satisfaction questionnaire, triage accuracy record form, and semi-structured interview guide. Quantitative data were analyzed using descriptive statistics and paired t-test, while qualitative data were analyzed using content analysis.

     The findings showed that the adapted ESI system included context-specific resource definitions for a community hospital, decision algorithms for common outpatient presentations, including cerebrovascular symptoms, chest pain, abdominal pain, respiratory conditions, elderly patients with atypical presentations, and pediatric patients, as well as age-stratified danger vital sign criteria. After implementation, triage accuracy increased significantly from 71.8% to 91.3% (p < 0.001), while under-triage and over-triage decreased. Nurses’ mean knowledge scores increased from 12.4 to 18.5 points, and all nurses passed the post-training competency assessment. Overall personnel satisfaction with the system was at a high level, with a mean score of 4.38 out of 5.00, and the perceived benefit domain received the highest score. Qualitative findings revealed that key success factors included participation among multidisciplinary personnel, administrative support, clear practice guidelines, and adaptation of the system to available resources in the community hospital setting.