Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Efficient triage in emergency departments (ED) is crucial for timely patient care, as evidence indicates that time to triage could affect treatment outcomes. Sex differences have been observed in different healthcare areas. The objective of this study was to determine whether sex differences exist in a patient’s time to triage and the magnitude of any observed differences at presentation to the ED of a Jerusalem hospital.

Methods: This retrospective study used anonymized data from adult ED visits between January 1 to September 30, 2024, at an ED in Jerusalem. Our primary outcome measure was the mean time to triage, defined as the interval between documented patient arrival and the first encounter with a triage nurse. Our secondary outcome measures included the proportion of patients triaged within 15 minutes, stratified by sex, ED division, and Emergency Severity Index (ESI) level.

Results: The study analyzed 30,447 adult ED visits over nine months. Mean time to triage was 10.9 minutes for women versus 10.3 minutes for men (absolute difference, 0.6 minutes; P < .001). Women were less likely to be triaged within 15 minutes (75.2% versus 76.9%; absolute difference, 1.7%; P < .001). Median time to triage was 6.0 minutes (interquartile range [IQR]) for men, 1.0-15.0 vs 7.0 minutes (IQR, 1.0-15.0) for women. Among patients with ESI levels 3-5, women had lower odds of triage within 15 minutes (odds ratio [OR], 0.78; 95% CI, 0.73–0.84; P < .001), while no significant sex differences were observed for ESI levels 1-2 (OR 1.30; 0.90–1.88; P = .17). Differences were most pronounced in ED triage to the ambulatory care area (absolute difference, 1.8%; OR, 0.95) and minimal in acute care (absolute difference, 0.5%; OR, 0.84), with no significant difference in the shock-trauma unit. Both sexes had similar triage rates within 60 minutes (99.2%).

Conclusion: Although we found statistically significant sex differences in time to triage, the absolute difference of 0.6 minutes is not clinically meaningful. The near-universal triage within 60 minutes suggests that early triage prioritization differences do not translate into clinically significant delays. Within this ED, triage processes function similarly for men and women. Future research should evaluate downstream processes (eg, time to physician evaluation) to determine aspects of ED care that may demonstrate clinically important sex-based disparities.