After formal reorganization of the emergency department of the St. Vincenz Krankenhauses, Limburg, a change in the patient admission process was accomplished. The aim was to improve patient satisfaction and treatment quality by optimizing personnel, diagnostic and spatial resources. In particular the focus was on shifting the initial assessment of treatment priority to the nursing staff. A structured primary assessment triage system (Manchester triage system, MTS) was implemented by which a symptom-based prioritization of patients into five categories can be achieved. In parallel with the development and installation of a software program linking computer-based MTS classifications to defined clinical pathways and diagnostic procedures, a standardized, documented assessment of treatment priority could be achieved in 95% of emergency patients. On average the time between patients' first contact with the nursing staff and treatment by a physician was shortened from 15 to 10 min. Using this standardized, documented and user-independent triage system, medical as well as forensic safety of the admission process in an emergency department was improved.
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