Triage is an effective method to streamline patient flow and shorten the delay for definitive care. We studied the effects of shift duties and patient volume on triage.

Patients presenting to the emergency department were tagged with a red, yellow, or green wristband as per the Simple Triage and Rapid Treatment (START) protocol. A mass-casualty incident (MCI) was defined as ≥7 red patients or ≥20 patients at one time. The data was analyzed using SPSS version 10.

Out of 25,928 patients, triage was performed for 25,468 (98.2%); 8,390 (32.3%) presented during the morning shift (08:00–14:00 hours), 7,119 (27.5%) during the evening shift (14:00–20:00 h); and 10,185 (39.2%) during the night shift (20:00–08:00 h). Of the patients, 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. Of the subjects, 1,431 (5.6%) were tagged red, 10,634 (41.7%) with yellow, and 13,424 (52.7%) were tagged green. Of the patients, 694 (2.7%) were retriaged. During the morning shift, 327 were tagged as red, 3,512 as yellow, and 4,465 as green, and 243 were retriaged. During the evening shift, 383 were tagged as red, 2,918 as yellow, and 3,685 as green, and 194 were retriage. During the night shift, 705 patients were tagged as red, 4,116 as yellow, and 5,165 as green. Sixteen MCIs occurred during the night shift, four during the morning shift, and one during the evening. Total numbers of patients presented during a MCI were 1,227. Of these, 102 were tagged as red, 463 as yellow, and 642 as green, and 79 were re-triaged.

High patient volume during the night shift hampers triage during peace time and MCIs.