The Impact of Standardized Triage Protocols on Nursing Performance in the Ophthalmology Emergency Department at King Khaled Eye Specialist Hospital

Abstract

Background: Emergency departments (EDs) particularly specialized units such as ophthalmology require rapid, accurate patient prioritization to optimize clinical outcomes and resource allocation. However, triage consistency can be compromised by heterogeneous clinical presentations, subjective assessments, and nurse-related factors, including variations in experience, workload, and stress. Implementing structured, standardized protocols like the Manchester Triage System (MTS) mitigates these challenges by reducing cognitive load, standardizing decision-making, and enhancing overall patient safety.
Aim: This study aimed to assess the impact of the Manchester Triage System on nursing performance outcomes, including adherence protocol, workload, perceived stress, and decision-making self-efficacy in an ophthalmology emergency department.
Design: A quasi-experimental pre/post-test study was utilized in the current study.
Setting: Ophthalmology emergency department at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Sample: All triage nurses working in the emergency department during the study period.
Tool: Four validated instruments were used: a protocol adherence scale, the modified NASA Task Load Index (NASA-TLX), the Perceived Stress Scale (PSS) and the Decision-Making Self-Efficacy Scale (DMSES).
Results: The results demonstrated statistically significant improvements following the implementation of MTS. Protocol adherence increased from a mean of 3.57 ± 0.90 pre-intervention to 4.40 ± 0.71 post-intervention (p < 0.001). Perceived stress significantly decreased from 3.39 ± 1.22 to 2.46 ± 1.09 (p< 0.001). Decision-making self-efficacy improved significantly from 2.53 ± 0.94 to 3.24 ± 0.96 (p< 0.001). Significant reductions were observed in workload dimensions, including mental demand (5.80 to 4.37, p = 0.004) and frustration (4.50 to 3.01, p = 0.001).
Conclusions: The implementation of the Manchester Triage System significantly improved multiple dimensions of nursing performance, including adherence to protocols, psychological well-being, and decision-making confidence.