Facilitators and barriers to triage efficiency in adult emergency departments: an integrative literature review

Purpose Triage is a critical process for patient prioritisation in emergency departments (EDs) that aims to rapidly allocate patients to the appropriate level of emergency care commensurate with clinical urgency. Triage completion is expected within two to five minutes while ensuring patient safety. The purpose of this review is to identify the facilitators and barriers to triage efficiency in EDs and provide an overview of how these factors impact the triage process. Procedures An integrative literature review was conducted with a structured search across six databases, including CINAHL, Embase, Medline, Scopus, ProQuest, and PubMed. Twenty studies met the inclusion criteria and were narratively synthesised. Findings Factors affecting triage efficiency were grouped under four themes. Process-related factors such as workflow designs, electronic triage support decision tools, “quick look” triage approaches, and system inefficiencies; nurse-related factors like experience, educational attainment, cognitive approach, and fatigue; environmental and system-related pressures such as interruptions, high patient volume, overcrowding, and availability of adequate triage spaces and equipment; and patient factors, including patient complexity, all shaped triage efficiency. Conclusion Triage efficiency is a dynamic and context-sensitive outcome shaped by multiple factors. Some factors are modifiable, and further studies are needed to explore targeted interventions and their impact on triage efficiency in emergency care.