Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners

Christien Van der Linden*, Robert Lindeboom, Naomi Van der Linden, Cees Lucas

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

10 Citations (Scopus)


Introduction: We developed a stream system to the current triangle system in order to manage patient flow at the emergency department and to clarify ENP role boundaries. Methods: Data on admission and death rates - indicating injury severity - and data on length of stay - indicating resource utilisation - were collected from 48,397 patients triaged in the Netherlands in 2009. Results: A total of 24,294 (50.2%) patients were triaged as 'suitable for treatment by an ENP' (ENP-stream). Remaining patients were triaged 'medium care' or 'high care'. In the medium and high care groups, significantly more admissions took place (6100, 25.3%) and significantly more patients died (31, 0.1%) compared to the patient group in the ENP-stream (admissions: 840, 3.5%, . p<. 0.001 and deaths 0, 0.0%, . p<. 0.001). The ENP-streaming is an accurate predictor of not needing to be admitted (PPV. =. 97%) and of ED survival (PPV. =. 100%). Mean length of stay was significantly shorter for patients in the ENP-stream compared to the other patients (back transformed values: 74 vs. 147. min, . p<. 0.001). Conclusion: This study showed excellent correlation between the ENP-streaming and patients' injury severity and resource utilisation, suggesting high internal validity of our triage streaming system. It clarifies the ENP role, minimising the subjectivity of patient allocation.

Original languageEnglish
Pages (from-to)52-57
Number of pages6
JournalInternational Emergency Nursing
Issue number2
Publication statusPublished - 2012
Externally publishedYes


  • Emergency care
  • Emergency nurse practitioner
  • Triage
  • Validation


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