Improving Emergency Nursing Triage Accuracy Through the QCTM-CTAS Model: A Systematic Review and Meta-analysis
Khalid Abdullah S. Alharbi *
School of Nursing, Lincoln University College, Petaling Jaya, Malaysia.
Faridah Mohd Said
Lincoln University College, Petaling Jaya, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Background: Emergency department triage accuracy is fundamental to patient safety, resource allocation, and clinical outcomes. The Canadian Triage and Acuity Scale (CTAS) provides a standardised five-level framework, yet its effectiveness depends critically on comprehensive, contextually adapted training. The Qassim Comprehensive Training Model (QCTM-CTAS) represents a localised intervention designed to address region-specific challenges in Saudi Arabian emergency departments.
Aim: This systematic review and meta-analysis synthesizes the evidence base for QCTM-CTAS, examining its impact on emergency nurses' triage competence, clinical decision-making, and patient assignment accuracy.
Methods: This systematic review and meta-analysis synthesised evidence from a mixed-methods study evaluating the QCTM-CTAS intervention across 196 emergency nurses in Qassim Region hospitals. Quantitative outcomes were analysed using nonparametric methods (Mann-Whitney U, Wilcoxon signed-rank tests) with effect sizes calculated as r = |Z|/√N. Qualitative data from 17 interviews underwent thematic analysis following Braun and Clarke's framework. Delphi methodology with seven experts established content validity.
Results: The intervention group demonstrated statistically significant improvements across all measured domains compared to controls. CTAS knowledge and understanding showed large between-group effects (U = 0.000, Z = -12.515, p < .001, r = 0.89). Clinical decision-making under Benner's framework improved substantially (Z = -7.505, p < .001, r = 0.76). Patient assignment accuracy demonstrated near-perfect separation between groups (U = 0.000, Z = -13.862, p < .001, r = 0.99). Strong positive correlations emerged between self-reported confidence and observed accuracy (Spearman's ρ = 0.877-0.925, p < .01). No significant associations were found between sociodemographic factors and post-intervention accuracy (p > 0.60), suggesting equitable training effects.
Conclusions: The QCTM-CTAS intervention produced large to very large effects on emergency nurses' triage competence across multiple domains. The comprehensive, context-adapted approach effectively bridged the gap between standardized CTAS guidelines and region-specific practice realities in Qassim, Saudi Arabia.
Keywords: CTAS, emergency nursing, simulation-based education, Saudi Vision 2030, patient safety, Benner's framework