Effectiveness of a structured triage system in improving timeliness of emergency care in a resource-limited rural hospital in Uganda

Background: Triage is essential for optimising resource allocation in emergency care, particularly in low- and middle-income countries. Some triage tools, such as the Interagency Integrated Triage Tool (IITT), have been developed specifically for resource-limited settings, but their implementation and evaluation remain challenging due to shortages of staff, limited training opportunities, and infrastructure constraints. This study aimed to evaluate the impact of implementing a structured triage system adapted from the IITT on the identification of urgent/emergency cases and wait times compared with unstructured nursing assessment alone in a rural general hospital in Uganda. Methods: A prospective quality improvement study was conducted in the outpatient department (OPD) of Dr Ambrosoli Memorial Hospital in Kalongo, Uganda. Data were collected on all patients attending the OPD for 7 consecutive days before and after IITT implementation. Outcomes included changes in emergency/urgent cases identification, proportion of undertriage/overtriage using hospital admission as the gold standard for assessing triage accuracy, OPD wait times and total OPD length of stay. Multivariable regression was used to adjust for confounders. Results: A total of 304 patients in the pre-implementation period and 246 patients in the post-implementation period were included in the analysis. After implementation of the IITT, the proportion of emergency/urgent cases increased from 16.4% to 22.8%, but there was no significant association between IITT implementation and identification of emergency/urgent cases, overtriage and undertriage after adjustment for confounders. IITT implementation was associated with a 23-minute reduction in time to provider (95% CI -35.49 to -12.03, p < 0.001) and a 35-minute reduction in total OPD length of stay (95% CI -57.41 to -12.76, p = 0.002). Conclusions: A structured triage system adapted from the IITT showed similar proportions of overtriage and undertriage compared with unstructured nursing assessment alone, but improved patient flow by significantly reducing wait times and length of stay in the OPD of a resource-limited rural hospital in Uganda. These findings suggest that structured triage can be feasibly implemented without additional resources in similar low-resource hospitals; however, further studies are needed to fully assess the impact of IITT in this and similar settings. © The Author(s) 2025.