Impact of Emergency Department Triage Process Optimization on the Prevention and Control of Cross-Infection: A Systematic Review
DOI:
https://doi.org/10.70088/d0bmkj17Keywords:
emergency department, triage, process optimization, cross-infection, infection prevention and control, systematic reviewAbstract
Objective To systematically evaluate the influence of emergency department (ED) triage process optimization on the prevention and control of cross-infection, to identify the intervention components supported by current evidence, and to grade the certainty of that evidence. Methods Following the PRISMA 2020 statement, eight Chinese and English databases (CNKI, Wanfang, CBM, PubMed, Embase, Web of Science, Cochrane Library and WHO IRIS) were searched from January 2020 to December 2025 for studies linking ED triage process optimization-pre-checkpoint screening, rapid pathogen detection, intelligent decision support, zoning and isolation restructuring, and patient flow management-with cross-infection related outcomes; foundational earlier works were added through citation searching. Methodological quality was appraised with AMSTAR-2, Joanna Briggs Institute (JBI) tools and AGREE II, and outcome-level certainty was rated with the GRADE approach. Results of 2 417 records retrieved, 22 studies were included, 19 of which were published within the recent five years. Rapid molecular screening at the ED entrance shortened the median time to pathogen result from 22.2 hours to 3.1 hours (P<0.001), reduced antibiotic administration at admission from 80.3% to 66.1% (P<0.001) and, combined with empiric contact precautions, was associated with a fall in carbapenem-resistant Enterobacterales acquisition from 4.6% to 1.0% and in antimicrobial consumption from 804 to 394 defined daily doses per 1 000 patients. Machine-learning triage models achieved superior discrimination to conventional scales (AUROC 0.917 vs 0.882), and big-data driven whole-process triage management raised triage concordance to 98.49% while shortening waiting time. Thirteen studies (59.1%) were rated high quality; outcome-level certainty was moderate for detection speed and antimicrobial stewardship and low to very low for multidrug-resistant organism acquisition and flow outcomes. Conclusion Triage process optimization functions as a transmission-interruption instrument at the hospital gateway rather than as a purely administrative procedure; its infection-control benefit depends on bundling rapid diagnostics, accurate stratification, pre-emptive isolation, crowding relief and continuous data feedback within adequately resourced infection prevention and control programmes. This review further finds that the certainty of the evidence is inversely related to its clinical importance, so its most consequential claims remain provisional and warrant standardised, multicentre prospective testing.References
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