• clinical guidelines;
  • compliance;
  • emergency departments;
  • implementation;
  • nurses;
  • nursing;
  • triage

Aims and objectives.  The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments.

Background.  In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first step performed by nurses when a patient arrives at an emergency department. It includes the prioritisation of patients to ensure that doctors see patients with the highest medical needs first. Although the national guideline was developed and disseminated in 2004, three years on there was no insight into the level of implementation of the guideline in practice.

Design.  A cross-sectional descriptive design.

Methods.  In February 2007, data were collected from ward managers and triage nurses at all emergency departments in the Netherlands (n = 108), using a questionnaire that was based on the recommendations and performance indicators of the guideline.

Results.  In total, 79% of all 108 Dutch emergency departments responded. The main findings showed that over 31% of the emergency departments did not use a triage system. Emergency departments using the Manchester Triage System had a mean adherence rate of 61% of the guideline’s recommendations and emergency departments using the Emergency System Index adhered to a mean of 65%.

Conclusion.  The guideline Triage in emergency departments was disseminated in 2004, but results from this study indicate that an improvement in adherence to this guideline is required.

Relevance to clinical practice.  Adherence to guidelines is important to standardise practice to ensure that patients receive the appropriate treatment and to improve quality of care.