XAVIER UNIVERSITY – ATENEO DE CAGAYAN

COLLEGE OF COMPUTER STUDIES AND

COLLEGE OF NURSING

TRIAGE SYSTEM

In partial fulfillment of the requirements for the course

NCM 110 – Nursing Informatics

Submitted by:

Daclag, Paolo Victor L.

Llorente, Alliah Sofia V.

Mackinnon, Allyssa Ciz Mae C.

Pasion, Janine Andrea T.

Submitted to:
Engr. Florence B. Reyes

March 10, 2020

Table of Contents

PHASE I: PLANNING PHASE............................................................................................................. 1

INTRODUCTION............................................................................................................................. 1
STATEMENT OF THE PROBLEM..................................................................................................2
PROPOSED SYSTEM....................................................................................................................... 2
OBJECTIVES................................................................................................................................... 3
SIGNIFICANCE OF THE PROPOSED SYSTEM.............................................................................3
SCOPE AND LIMITATIONS............................................................................................................ 3
PHASE II: ANALYSIS PHASE............................................................................................................. 4
SWIMLANES WORKFLOW............................................................................................................ 4
FUNCTIONAL DESIGN DOCUMENT.............................................................................................5
DATA ANALYSIS............................................................................................................................ 6
DEFINITION OF DATA FOR DEVELOPMENT..............................................................................6
USERS’ REQUIREMENTS............................................................................................................... 8
PHASE III: SYSTEM DESIGN PHASE................................................................................................9
CONCEPTUAL FRAMEWORK.......................................................................................................9
USER INTERFACE........................................................................................................................ 10
REFERENCES................................................................................................................................... 19
APPENDIX......................................................................................................................................... 20
GROUP MEMBER’S PROFILE......................................................................................................20
GANTT CHART............................................................................................................................. 24
PHASE I: PLANNING PHASE

INTRODUCTION -LYS
The emergency department (ED) of a hospital is responsible for the provision of medical and
surgical care to patients arriving at the hospital in need of immediate care. For many hospitals, the
emergency department is the hub for patient entry. Hence, it has become the first point of contact for
patients. People with varying injuries and illnesses enter the emergency room and expect the best care
in the fastest time. While hospitals still deal with critical emergencies, patients with minor ailments
enter the space too. A proper emergency department management ensures that the right resources are
in place to help patients on time. Across the world, emergency departments are facing increasing
challenges due to growing patient numbers and an inability to flex capacity to meet the demands
(McHugh 2011). Public hospitals in the Philippines are facing this challenge. Consequently,
emergency department crowding has become an omnipresent phenomenon. Overcrowding in the
emergency department is a problem that must be addressed. Waiting times in the emergency
department are a source of dissatisfaction among patients. Therefore, improving patient flow within
the emergency department is ultimately achieved by reducing the amount of time patients spend in the
department, thereby reducing departmental crowding. The shorter each patient journey times are
associated with improved patient satisfaction. Because of these pressures, a triage system performed
by either a physician or nurses has been formalized.

A triage system is a brief intervention that should occur ideally within 10-15 minutes of the
patient’s arrival in the emergency department. According to Rowe (2012), the aim is to stratify the
patient’s clinical presentations and prioritize them accordingly as a way of allocating resources, such
as staff and physical space based on their clinical need. With this, it is primarily used to prioritize
treatment based on the resources of the unit and in the degree of urgency. A triage system distributes
the workload of the ED for better utilization and optimization of resources. Hospitals that utilize a
triage system redistribute, reduce the waiting times, and admission rates. This ultimately leads to
increase efficiency and effectiveness of the emergency department, enhanced patient and family
satisfaction, through earlier patient diagnosis and treatment. Furthermore, there is an improved quality
of health care. With this, a triage system in the emergency department is progressively instrumental in
ensuring high quality and timely patient care.

Northern Mindanao Medical Center (NMMC) is one of the public hospitals in the Philippines
located at Cagayan de Oro City. It envisions being a center for excellence in ASEAN healthcare by
2025. The institution is committed to providing the most comprehensive, accessible, efficient,
affordable, and quality health care. And to integrate technological advances with compassionate,
ethical best practices in patient care in a safe and secure environment. In light of this, one of the
features seen in the hospital is their triage system that is incorporated in their Emergency Department
and Obstetric Emergency Department.

The current practice of NMMC in their Emergency department triage system can be
summarized into three steps: First, the clerk receives the patient upon entering the emergency
department and provides a data slip to fill up. Second is the focused physical assessment and history
obtained by the physician. Third, the triage nurse obtains the vital signs of the patient. The priority
level is assigned either by the physician or triage nurse. After, the triage nurse records all the data

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obtained. Currently, there are four levels in NMMC’s triage system. The critical level requires care
within 30 seconds. This involves a life-threatening situation such as airway obstruction. The emergent
level requires care within 10 minutes. These involve sensorial changes and unstable vital signs. The
urgent level requires care within 30-60 minutes. It includes a non-disabling condition but requires
further diagnostic. The non-urgent level requires care within 60-120 minutes. It includes those who do
not require immediate help such as stable medical conditions.

An enhanced triage system that aims to improve the existing system that can increase patient
flow and satisfaction will be proposed in this hospital institution – NMMC, specifically, in its
Emergency Department.

STATEMENT OF THE PROBLEM - ANYA

Northern Mindanao Medical Center is a public hospital that faces numerous patients in their
emergency department where ill patients usually enter. A triage system is one of the features in the
emergency department where patients are assigned to a priority level according to their needs; a
lengthy assessment is one of the components of the system. This lengthy assessment is one of the
factors that can contribute to overcrowding in the emergency department for it takes time and leads to
a decrease in patient flow. Furthermore, there is a need for better prioritization levels to ensure
accurate treatment is given, and to allocate resources accordingly.

PROPOSED SYSTEM -LYS

Whenever a patient arrives in an emergency department, one of the first steps in their care
process is the triage. It is an opportunity for a healthcare team member to identify critically ill patients
and assign priority treatment levels. Hospitals need timely, meaningful, and extensible adjustments
with the delivery of emergency care. In order, to provide high-quality care to individuals and families
with intent to get the desired outcome, first, there should be no harm, also without waste of resources,
and constantly with an exceptional experience for each person, family, and team member. Hence, an
improved triage system is a part of an effort to better its overall services. This proposal aims to
provide a better triage system that can facilitate excellent workflow and satisfaction whilst maintaining
the user-friendly system.

The newly improve triage system is inclusive with these changes: (1) shortened assessment, (2)
incorporate five priority levels, and (3) able to cross-reference and compare with previously existing
data. First, for the shortened assessment. Assessment is a critical data needed to begin treatment and
care. Instead of asking and doing a lengthy assessment that contributes to delays in care, the improved
system uses five key areas to assess. These are the airway, breathing, circulation, mental status, and
pain. Vital signs and brief health history are also included. It scaled down the list of questions and
assessments to ensure a rapid triage process and placement in appropriate care, limiting to those
needed to determine the severity of illness. Second, a triage system that is composed of five different
priority levels. It ranges from level 1 for patients who are the most critically sick, to the 5th level for
patients who are the least sick. This determines in which area of the emergency department that
patients will be seen, places the patient in a queue, and influences provider decision-making
throughout the patient’s care process. In level one are patients who need to have treatment
immediately or within two minutes. They are categorized as having an immediately life-threatening
condition. In level two, are patients who need to have treatment within 10 minutes. They are

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categorized as having an imminently life-threatening condition. In level three, are patients who need to
have treatment within 30 minutes. They are categorized as having a potentially life-threatening
condition. In level four, patients who need to have treatment within one hour and are categorized as
having a potentially serious condition. And in level five, patients who need to have treatment within
two hours are categorized as having a less urgent condition. The triage nurse/physician assigns the
level according to the complaints expressed by the patient and from the assessment data. To further
help, the new system will aid. The system is able to look for past patients that had the exact or similar
clinical presentations and level assigned, after the system then displays the results. This can lead to a
better differentiation in patients’ priority levels for the in-charge nurse/physician can have a reference,
which in turn, helps patients get the appropriate care they need.

OBJECTIVES - ALLIAH
The proposed system aims to:
 Improve the current triage system
 Reduce overcrowding and increase patient flow
 Incorporate a five priority levels
 Expedite care of patients through a shortened assessment

SIGNIFICANCE OF THE PROPOSED SYSTEM - ALLIAH

This proposed system is beneficial to the following:
Physicians of Northern Mindanao Medical Center. Physicians are primarily in charge of the
treatment of the patient. Through this proposed system, physicians will be able to efficiently and
effectively provide treatment, and appropriate intervention that fits the patient’s concerns, this will
lead to excellent patient outcomes.
Nurses of Northern Mindanao Medical Center. A triage nurse is positioned in an emergency
department and is responsible for assessing patients and determining their level of need for medical
assistance. Through this proposed system, a triage nurse will be able to conduct a rapid assessment,
assign appropriate priority levels, and allocate resources accordingly. Furthermore, nurses will be able
to provide the appropriate care plan, hence, increasing productivity.
Patients. Patients expect a proper treatment and management ones they enter the hospital. Through
this proposed system, patients are catered promptly, thus reducing their waiting time. Also, reduced
waiting time, receive proper care and management that fits their condition, consequently, increasing
patient satisfaction.
Other healthcare staff of Northern Mindanao Medical Center. The other healthcare staffs such as
medical technologists and radiologists are also involved in the care of the patient. Through this
proposed system, collaboration within healthcare professionals can increase, leading to better
performance and healthcare outcomes.

SCOPE AND LIMITATIONS - PAOLO

This proposed system is implemented at Northern Mindanao Medical Center (NMMC),
specifically, in the Emergency Department. The system focuses on improving the current triage
system through a shortened assessment, five priority levels, and a cross-reference feature. It is
accessible by doctors, nurses, and other members of the allied health care team to better help them in
assigning patients to their respective settings. The system, on the other hand, is limited to its design,
function, and area of implementation.
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 PHASE II: ANALYSIS PHASE LYS

Emergency Department Triage System Workflow

CLERK NO
Is there a
Ask for the concern concern?

YES

Provide patient data slip to fill up

PATIENT
Enters emergency room and
Patient Enters presents the filled up slip

TRIAGE
PHYSICIAN
Patient is received Get chief complaint Conduct focused
assessment

TRIAGE
NURSE Cross-reference Assign triage level
Obtain vital Record patient data
signs

Logs in to the system

NO
New
Retrieved data admission
?

YES
Forward patient
for treatment Update record Enter data Create new profile

LOG-OUT

PHYSICIAN

Initiate patient Patient receive

treatment treatment
END
TRANSACTION

FIGURE 1. SWIMLANES WORKFLOW

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TABLE 1. FUNCTIONAL DESIGN DOCUMENT - ANYA

The table below shows the functional design document that can be seen in the proposed
system. A functional design document is part of a set of software specifications that outlines the
features of the system. It aims to define the purpose and scope of the functions that are within the
system. The functional design document is as follows:
FUNCTION DESCRIPTION
Sign-up It creates an account and registers the information of the user in the system.
Log-In It is the feature that allows the user to gain access to a computer system by identifying and
authenticating themselves. It requires the username and the password of the user.

Create New Patient File It creates a new file for the newly admitted patient to the triage system where information is
entered and displayed.

Retrieving Patient Data It is obtaining past patient data from the system.

Data Entry Inputting data or information into the system.

Cross-reference The system compares the complaint/clinical manifestations of the current patient to past
patients and shows the results to aid in an accurate assigning of triage priority level.
Update It adds developments and information to patient’s file regarding their status.
Home It directs the user to the main page of the system where options are chosen.
Edit It is used in correcting or otherwise modifying information.
Search It is used to find information needed at a faster rate through typing the keyword needed.
Options The system provides options whether the user wants to create or retrieved data and to cross
reference data.

Add It allows user to add information.

Undo It allows a user to cancel or reverse the last one or more changes executed.
Redo It restores any actions that have been previously undone.
Delete It removes unwanted or wrong information by highlighting the area and clicking the delete
button.
Review It is used to view all the patient information in one page before updating or finalizing the
record.

Log-out It is a feature that is used to conclude the use of a computer, database, or system.

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DATA ANALYSIS

TABLE 2. DEFINITION OF DATA FOR DEVELOPMENT - PAOLO

The table below shows all the data found and displayed in the system. It is the data that can be
seen, needed, and stored in the proposed system. The data includes patient assessment, arrival
information, health history, treatment, and observation data. Also, the user data requirements required
to access the system. All of these data are needed to complete the patient information in the proposed
triage system. The following are the data:
DATA DESCRIPTION
Full name The full name of the staff is needed when creating an
account in the system.
License No. The license number of the staff is needed when creating
an account.
Username The identification used by the user to access the system.

Password A password is required after entering the username.

Case number The number assigned to the patient by the hospital.
Room Number The room number where the patient is admitted.

Attending Physician The name of the current attending physician of the

patient.

Nurse in charge The name of the nurse in charge for the care of the
patient.

Department The respective department to which the patient was

forwarded to cater their need and initiate treatment.

Patient information The patient’s general information such as name, age,

address, contact number, civil status, and religion is
displayed on the general information section.
Patient assessment The airway, breathing, circulation, mental status, and
pain that was assessed upon the arrival of the patient.
Vital signs are also included.
Chief complaint This is the problem identified by the patient.
Vital signs The blood pressure, heart and respiratory rate,
temperature, and the oxygen saturation of the patient
before and after being admitted to the hospital.
Signs and symptoms The signs and symptoms shown by the patient before
and after being admitted to the hospital.
Diagnosis The diagnosis is formulated from the complaint and
clinical manifestations that was observed from the
patient during assessment.
Triage level The triage level assigned to the patient based on the
urgency of their need.
Previous diseases The previous disease or illness experienced by the
patient.
Medical/Surgical history The medical intervention and surgery experienced by
the patient.
Family history The family history of the patient includes: familial
illness.
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 Current medication The medications that is currently taken by the patient.
Allergy It refers to any allergies that the patient has.
Required diagnostic laboratory tests The tests required to further inspect the patient and
provide care.
Treatment The appropriate treatment given to the patient.
Medication prescribed The medications that the patient should take.
Doctor’s order This includes the test, interventions, treatment that is
carried out.
Nurses’ notes The care plan initiated by the nurse based on the current
need of the patient.
Progress’ notes It is based from the progress that can be seen from the
patient all throughout the stay in the hospital.
Referrals It involves referrals to other department in the hospital.

Laboratory test results The results of the diagnostic procedures.

Discharge plan The medications and treatment that must be followed by
the patient after being discharged.

TABLE 3. USERS’ REQUIREMENTS - ALLIAH

The User requirement contains the requirements for specific users and the limitations of what
they can only access. The function of the user requirement is to describe what the user does with the
system. This includes the activities that the user must be able to perform. The admin has full access to
the system assigned to them, which means the user can manage any activity about the system. It is the
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highest privilege to those who can access the specific system. The key functions for admin are they
can keep track of patient details, test details, the progress of the patient and generate a report through
the data provided by the different users. On the other hand, general users are those that can only view
specific data from the system. The user requirements are as follows:

USER ACCESS DESCRIPTION

Registered Emergency  ADMIN  Access Data

Triage Nurse - General patient information  View Data
- Arrival information  Input Data
- Health history  Edit Data
- Treatment information  Delete Data
- Observation data
Physician  ADMIN  Access Data
- General patient information  View Data
- Arrival information  Input Data
- Health history  Edit Data
- Treatment information  Delete Data
- Observation data
Other Health Care  ADMIN  Access Data
Provider/Member - General patient information  View Data
- Arrival information  Input Data
- Health history  Edit Data
- Treatment information  Delete Data
- Observation data

ER Clerk  GENERAL  Access Data

- General patient information  View Data

PHASE III: SYSTEM DESIGN PHASE

CONCEPTUAL FRAMEWORK - PAOLO

The Input-Process-Output Model (IPO) is a conceptual paradigm that shows the inputs,

required processing of tasks, and the output. The model will transform the input into an output. As
shown in below, the input represents the flow of data and materials into the process from the outside.

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Meanwhile, the process consists includes all tasks required to effect a transformation of the input. The
output is the data and materials flowing out of the transformation process, thus it is the result.

USER INTERFACE

A user interface is the means in which a person controls a software application or hardware
device. It is the access points where users interact with designs of the system. User Interface focuses
on what users might need to do and ensuring that the interface has elements that are easy to access,
understand, and use to facilitate those actions. With this, brings together concepts from interaction
design and visual design. The user interface of our proposed system maintains its user-friendly
characteristics and aims to be a simple yet better interface for its users.

Display LYS
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 - This is the standard display when the system is not being used.

Create an Account LYS

- This is the design when
the member of the
healthcare team creates
his/her account in
the system.

Log in ALLIAH

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 - This is the design whenever the user logs in to the system; the username and the password are
required.

HOME ALLIAH
- This is the design of the home page of the system.

HOME – New Patient Option - ANYA

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 - This is the new patient option chosen whenever the patient being admitted is new. The user is
directed towards a new patient data.

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 HOME - RETRIEVED PATIENT DATA OPTION - ANYA
- This option allows the user to search and retrieved the past patient data in order to record new
information.

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 HOME - CROSS-REFERENCE OPTION - ANYA
- This is the design of the cross reference option. It allows the user to search for similar chief
complaint and triage level assigned to compare and aid them in assigning patient through
displaying the search results.

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 PATIENT INFORMATION - PAOLO
16
 - This is the design for the patient information where all the data about the patient can be
viewed.

REVIEW - PAOLO
- This is the design that allows the user to view the patient information simultaneously.

LOG OUT - PAOLO

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 This design concludes the use of the system.

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REFERENCES

Electronic Triage Tool Improves Patient Care in Emergency Departments - 09/25/2017. (2017,
September 25). Retrieved from:
https://www.hopkinsmedicine.org/news/media/releases/electronic_triage_tool_improves_patient_care
_in_emergency_departments

Emergency Severity Index (ESI): A Triage Tool for Emergency. Retrieved from:
https://www.ahrq.gov/professionals/systems/hospital/esi/esitab8-3.html

Hospital Triage. Retrieved from

https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/Pages/triage.aspx

How Emergency Departments Work: Triage System. 08/05.2019 (2019 August 05) Retreieved from
https://www.health.qld.gov.au/news-events/news/emergency-departments-triage

Subash F, Dunn F, McNicholl B, et alTeam triage improves emergency department

efficiencyEmergency Medicine Journal 2004;21:542-544. Retrieved from
https://emj.bmj.com/content/21/5/542.info

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APPENDIX

GROUP MEMBER’S PROFILE

Paolo Victor L. Daclag

Golden Glow North 1, Pueblo de Oro,

Upper Carmen Cagayan de Oro City,
9000
viktxr@gmail.com
09063005525

SUMMARY
2nd Year Nursing student with a background on basic Accountancy, Marketing, and Finance. Ready
to learn and make new experiences. Ambitious with a strong work ethic.

EDUCATION

SENIOR HIGH SCHOOL

Xavier University – Ateneo de Cagayan Senior High School
2016-2018

COLLEGE
Xavier University – Ateneo de Cagayan
Bachelor of Science in Nursing
2018-present

SKILLS

 Basic First Aid

 Basic Life Support
 MS Word, PowerPoint, Excel
 Willingness to work with others

ORGANIZATIONS

 XU CSG – ELECOM staff (2018- present)

 XU RCY – Budget & Finance Officer (2016 – present)
 XU CONUS – DMSA Member (2018-present)

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 Alliah Sofia V. Llorente
Xavier Estates Cagayan De Oro
- Xavier Estates, Fr. Masterson Ave.,
Upper Balulang, 9000 Cagayan de Oro,
alliah_llorente@yahoo.com
09989999624
SUMMARY
Responsible and ambitious student with excellent time management. Possess proven communication
skills and strong work ethic.

EDUCATION

SENIOR HIGH SCHOOL

Corpus Christi School
2016-2018

COLLEGE
Xavier University – Ateneo de Cagayan
Bachelor of Science in Nursing
2018-present

SKILLS

 Excellent written and verbal communication

 Ability to analyze, diagnose, suggest and implement process change
 Proficient in Microsoft products and PC skills
 Ability to exercise judgment while working independently
 Working knowledge of varied clinical areas

ORGANIZATIONS
 Ateneo Camera Club

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#955 Zone 4 Agusan Cagayan de Oro
City, 9000
mackinnonallyssa@gmail.com
09361849357

SUMMARY
Enthusiastic and eager to contribute to team success through hard work, attention to detail and excellent
organizational skills. Clear understanding of the tasks. Motivated to learn, grow and excel in every
aspect. Observant with time management skills and willing to work on research tasks with peers.

EDUCATION

SENIOR HIGH SCHOOL

Xavier University – Ateneo de Cagayan Senior High School
2016-2018

COLLEGE
Xavier University – Ateneo de Cagayan
Bachelor of Science in Nursing
2018-present

SKILLS

 Data Collection
 Project Management
 Documentation
 Data Analysis
 Research
 Time management
 Data Entry

ORGANIZATIONS
 ACIL

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 Janine Andrea T. Pasion
#51 and 52, Mandumol, Macasandig,
Aluba, Cagayan de Oro Ciy, 9000
Anya.pasion@gmail.com
09209555378

SUMMARY
Willing to learn new techniques and skills to be of help to a project. Would give effort to improve any mistake for the
greater good of the team project.

EDUCATION

SENIOR HIGH SCHOOL

Xavier University – Ateneo de Cagayan Senior High School
2016-2018

COLLEGE
Xavier University – Ateneo de Cagayan
Bachelor of Science in Nursing
2018-present

SKILLS

 Data Collection
 Documentation
 Research
 Resourcefulness
 Providing written output
 Multitasker

ORGANIZATIONS
 CONUS

GANTT CHART

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GANTT CHART

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