Enhancing Efficiency in Public Healthcare’s Specialized Departments with Triage Protocol

Authors

  • Nancy Koros * Department of Mechanical Engineering, School of Engineering, Dedan Kimathi University of Technology, Nyeri, Kenya.
  • James Wakiru Department of Mechanical Engineering, School of Engineering, Dedan Kimathi University of Technology, Nyeri, Kenya. https://orcid.org/0000-0002-3645-1271
  • Peter Muchiri Department of Mechanical Engineering, School of Engineering, Dedan Kimathi University of Technology, Nyeri, Kenya. https://orcid.org/0000-0001-6176-5240
  • Simon Muhiu Department of Mechanical Engineering, School of Engineering, Dedan Kimathi University of Technology, Nyeri, Kenya. https://orcid.org/0009-0003-5083-7044

https://doi.org/10.22105/ahse.vi.41

Abstract

Public healthcare in low-resource settings continues to face challenges as demand for services grows faster than available resources, resulting in longer waiting times, a significant challenge. This study evaluated patient flow using a discrete-event simulation model, incorporating the triage protocol to assess its impact on waiting times, Length of Stay (LOS), and resource utilization. Arrivals, service times, and resource availability data were collected, a model was developed, verified, and validated against real-world operations, and triage-based improvement scenarios were simulated. Results revealed major bottlenecks in antenatal and gynecology consultations, triage, and delivery units, where patients faced the most extended delays and resources were overstretched. Implementation of the triage protocol showed limited effect under current staffing, but when combined with optimized resourcing, waiting times in high-pressure areas were nearly eliminated, and overall LOS was reduced by 5.6% in the Labour and Delivery (L/D) clinic and 12.1% in the Mother Child Health (MCH) clinic. The study concludes that triage protocols are effective in improving patient flow when integrated with resource optimization and workflow redesign. This research provides new evidence on resource-sensitive strategies that can enhance maternity care performance and inform policy for scaling maternal health interventions under Universal Health Coverage (UHC) in low-resource contexts. 

Keywords:

Discrete event simulation, Triage tool, Maternity, Labour and delivery, Low resource

References

  1. [1] Ahmad, J., Iqbal, J., Ahmad, I., Khan, Z. A., Tiwana, M. I., & Khan, K. (2020). A simulation based study for managing hospital resources by reducing patient waiting time. IEEE access, 8, 193523–193531. https://doi.org/10.1109/ACCESS.2020.3032760
  2. [2] Majamanda, M. D., Joshua Gondwe, M., O’Byrne, T., Makwero, M., Chalira, A., Lufesi, N., … ., & Desmond, N. (2022). Capacity building for health care workers and support staff in pediatric emergency triage assessment and treatment (ETAT) at primary health care level in resource limited settings: Experiences from Malawi. Comprehensive child and adolescent nursing, 45(2), 201–216. https://doi.org/10.1080/24694193.2021.1916127
  3. [3] Zachariasse, J. M., Van Der Hagen, V., Seiger, N., Mackway-Jones, K., Van Veen, M., & Moll, H. A. (2019). Performance of triage systems in emergency care: A systematic review and meta-analysis. BMJ open, 9(5), 1–9. https://doi.org/10.1136/bmjopen-2018-026471
  4. [4] Swart, A. T., Muller, C. E., & Rabie, T. (2018). The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa. Health sa gesondheid, 23. https://doi.org/10.4102/hsag.v23i0.1097
  5. [5] Al Nhdi, N., Al Asmari, H., & Al Thobaity, A. (2021). Investigating Indicators of waiting time and length of stay in emergency departments. Open access emergency medicine, 13(null), 311–318. https://doi.org/10.2147/OAEM.S316366
  6. [6] Donabedian, A. (1996). Health services research I. A series of papers commissioned by the health services research study section of the united states public health service (Vol. 44).
  7. [7] Wangia E, K. C. (2016). Policy brief refocusing on quality of care and increasing demand for services; Essential elements in attaining universal health coverage in Kenya Executive Statement.
  8. [8] UHC2030. (2017). Healthy systems for universal health coverage A joint vision for healthy lives.
  9. [9] Lang, E., Mwanri, L., & Temmerman, M. (2019). Effects of implementing free maternity service policy in Kenya : An interrupted time series analysis, 1–10. https://doi.org/10.1186/s12913-019-4462-x
  10. [10] Orangi, S., Kairu, A., Malla, L., Ondera, J., Mbuthia, B., Ravishankar, N., & Barasa, E. (2021). Impact of free maternity policies in Kenya : An interrupted time- series analysis, 1–11. https://doi.org/10.1136/bmjgh-2020-003649
  11. [11] Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare : A systematic literature review, 6, 1–12. https://doi.org/10.1186/s12913-021-07097-6
  12. [12] Blythe, N., & Ross, S. (2022). Strategies to reduce waiting times for elective care.
  13. [13] Rohleder, T. R., Lewkonia, P., Bischak, D. P., Duffy, P., & Hendijani, R. (2011). Using simulation modeling to improve patient flow at an outpatient orthopedic clinic. Health care management science, 14(2), 135–145. https://doi.org/10.1007/s10729-010-9145-4
  14. [14] Alenezi, N. F., Alenezi, H. F., Alenazi, H. S., Alsuaibi, A. E., Khushaim, H. M., Shubayli, K. I., & Almutairi, H. D. (2023). Systematic review of triage-related interventions to improve patient flow in emergency departments, 11(1), 237–245. https://doi.org/10.5281/zenodo.8314755
  15. [15] Brasme, J. F., Morfouace, M., Grill, J., Martinot, A., Amalberti, R., Bons-Letouzey, C., & Chalumeau, M. (2012). Delays in diagnosis of paediatric cancers: A systematic review and comparison with expert testimony in lawsuits. The Lancet Oncology, 13(10), e445-e459. https://doi.org/10.1016/S1470-2045(12)70361-3
  16. [16] Madigan, M. (2023). Triage. In Disaster response practices : Guide to mass casualty/mass fatality management planning (pp. 61–77). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-42147-1_6
  17. [17] ACOG. (2019). Interim Update, 134(792), 122–125.
  18. [18] Mitchell, R., O’reilly, G., Banks, C., Nou, G., McKup, J. J., Kingston, C., … ., & Cameron, P. (2025). Triage systems in low-resource emergency care settings. Bulletin of the world health organization, 103(3), 204–212. https://doi.org/10.2471/BLT.23.290863
  19. [19] Mitchell, R. (2023). Triage for resource-limited emergency care: Why it matters. Emergency and critical care medicine, 3(4), 139–141. https://doi.org/10.1097/EC9.0000000000000082
  20. [20] Hinson, J. S., Martinez, D. A., Cabral, S., George, K., Whalen, M., Hansoti, B., & Levin, S. (2018). Triage performance in emergency medicine : A systematic review. Annals of emergency medicine, 1–13. https://doi.org/10.1016/j.annemergmed.2018.09.022
  21. [21] Ibrahim, B. E. (2022). Sudanese emergency departments: A study to identify the barriers to a well-functioning triage. BMC emergency medicine, 22(1), 1–7. https://doi.org/10.1186/s12873-022-00580-1
  22. [22] Wasingya-Kasereka, L., Nabatanzi, P., Nakitende, I., Nabiryo, J., Namujwiga, T., & Kellett, J. (2021). Two simple replacements for the triage early warning score to facilitate the South African triage scale in low resource settings. African journal of emergency medicine, 11(1), 53–59. https://doi.org/10.1016/10.1016/j.afjem.2020.11.007
  23. [23] Hansoti, B., Jenson, A., Keefe, D., De Ramirez, S. S., Anest, T., Twomey, M., … ., & Wallis, L. (2017). Reliability and validity of pediatric triage tools evaluated in Low resource settings: A systematic review. BMC pediatrics, 17(1), 1–9. https://doi.org/10.1016/10.1186/s12887-017-0796-x
  24. [24] Hands, C., Hands, S., Verriotis, M., Bunn, J., Bailey, E., Samuels, R. J., … ., & Taylor, S. (2021). Emergency triage assessment and treatment plus (ETAT+): Adapting training to strengthen quality improvement and task-sharing in emergency paediatric care in Sierra Leone. Journal of global health, 11. https://doi.org/10.1016/10.7189/JOGH.11.04069
  25. [25] WHO. (2020). Clinical Care Severe Acute Respiratory Infection. Toolkit. WHO technical report series, 196.
  26. [26] Best, R., Turay, J., & Sesay, N. (2020). Implementation of a novel obstetric triage tool in the tertiary maternity hospital of Sierra Leone : A quality improvement project, 12, 90–96. https://doi.org/10.1016/10.5897/IJNM2020.0418
  27. [27] Easterbrook, J. F. (2015). The introduction of the new symptom specific obstetric triage system (SOTS) in an acute care trust: An examination of the views and experiences of midwives. https://etheses.bham.ac.uk/id/eprint/5643/
  28. [28] Hesham, A., Ali, M., Elsheikh, M., Abed-Elhamid, N. (2022). Application of triage protocol to improve quality of care in emergency unit at maternity hospital (1). Original Article Egyptian Journal Of Health Care (Vol. 13).
  29. [29] Quaile, H. (2018). Implementing an Obstetrics-Specific Triage Acuity Tool to Increase Nurses’ Knowledge and Improve Timeliness of Care. Nursing for women’s health, 1–9. https://doi.org/10.1016/j.nwh.2018.05.002
  30. [30] Hesham A. (2022). Application of triage protocol to improve quality of care in emergency unit at maternity hospital (1). Original article egyptian journal of health care (Vol. 13). https://doi.org/10.21608/ejhc.2022.214079
  31. [31] Mitchell, R., Bue, O., Nou, G., Taumomoa, J., Vagoli, W., Jack, S., … ., & Cameron, P. (2021). The lancet regional health - western pacific validation of the interagency integrated triage tool in a resource-limited , urban emergency department in Papua New Guinea : A pilot study. The lancet regional health - western pacific, 13, 100194. https://doi.org/10.1016/j.lanwpc.2021.100194
  32. [32] Rossetti, M. D. (2015). Simulation modeling and Arena. John Wiley & Sons.
  33. [33] Law, A. M., Kelton, W. D., & Kelton, W. D. (2007). Simulation modeling and analysis (Vol. 3). New York: Mcgraw-hill.

Downloads

Published

2025-08-16

Issue

Vol. 2 No. 3 (2025): Annals of Healthcare Systems Engineering

Section

Articles

Categories

How to Cite

Koros, N., Wakiru, J., Muchiri, P., & Muhiu, S. (2025). Enhancing Efficiency in Public Healthcare’s Specialized Departments with Triage Protocol. Annals of Healthcare Systems Engineering, 2(3), 145-158. https://doi.org/10.22105/ahse.vi.41

Similar Articles

You may also start an advanced similarity search for this article.