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Objectives Emergency department (ED) lengths of stay are measured from the time ofpatient registration or triage. The time that patients wait in line prior toregistration and triage has not been well described. We sought to characterizepre-triage wait times and compare them to recommended physician response times,as per the Canadian Triage and Acuity Scale (CTAS). Methods This observational study documented the time that consenting patientsentered the ED and the time that they were formally registered and triaged.Participants’ CTAS scores were collected from the electronic record. Patientsarriving to the ED by ambulance were excluded. Results A total of 536 participants were timed over 13 separate intervals. Ofthese, 11 left without being triaged. Participants who scored either CTAS 1 or2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1)minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6,24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, andCTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patientssubsequently categorized as CTAS 1 or 2, 20.8% waited longer than therecommended time-to-physician of 15 minutes to be triaged. Conclusions All urban EDs closely follow patients’ wait times, often stratifiedaccording to triage category, which are assumed to be time-stamped upon apatient’s arrival in the ED. We note that pre-triage times exceed the CTASrecommended time-to-physician in a possibly significant proportion of patients.EDs should consider documenting times to treatment from the moment of patientarrival rather than registration.

A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations