Nurses’ decision-making in the Manchester Triage System: influencing factors and improvement strategies*

Abstract

ABSTRACT Objective: To explore nurses’ perceptions of decision-making in the Manchester Triage System, including implications for patient safety and improvement strategies. Method: A qualitative and exploratory study was conducted in an emergency department in northern Portugal. Convenience sampling included ten nurses with over two years of triage experience. Semi-structured interviews were performed in May 2025 and analysed using Bardin’s content analysis. Results: Triage was perceived as an essential contributor to patient safety by prioritising complaints and defining appropriate waiting times. Decision-making was influenced by nurse-related factors, patient-related factors, triage system limitations, and organisational context. Suggested improvements included audits, protocol revision, structured pain assessment, integration of early warning scores, ongoing training/recertification, mentorship, better information system interoperability, and institutional measures to reduce interruptions. Conclusion: Triage decision-making is multifactorial and requires continuous professional development and organizational support.