Mental Health Triage in Emergency Medicine

TLDR

The study aimed to develop a National Triage Scale–aligned Mental Health Triage Scale for emergency department patients and to shorten waiting and transit times while improving mental health assessment skills. The MHTS was created as a four‑tiered system, implemented with a structured education package, and evaluated over two years using combined mental health and medical information. Implementation of the MHTS reduced emergency waiting and transit times, increased triage consistency and admission appropriateness, improved patient satisfaction, and was deemed suitable by liaison psychiatry with continued use at two‑year follow‑up.

Abstract

The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems.We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years.A four-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health 'did not waits' showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up.A systematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.