Association of a Triage-Based Emergency Alarm System with Waiting Times and Clinical Outcomes in a Pediatric Emergency Department

Background/Objectives: Pediatric emergency departments (PEDs) experience abrupt fluctuations in patient volume that can prolong waiting times and compromise timely care for critically ill children. The aim of this study was to evaluate whether implementation of a triage-based emergency alarm was associated with time to electronic documentation of initial physician evaluation and clinical outcomes during the 2022 COVID-19 Omicron wave in Taiwan. Methods: We conducted a single-center retrospective before-and-after observational study of PED visits from 1 April to 31 October 2022. The emergency flashing-light alarm was implemented on 1 August 2022 to alert physicians to triage level 1 patients requiring immediate evaluation. Propensity scores were estimated using age group (<5 versus 5–17 years), sex, and availability of additional physician staffing support; 1:1 matching yielded 7467 pairs. The matched-pair structure was retained in bootstrap confidence intervals and permutation tests for waiting-time comparisons. Results: The analysis included 19,624 visits (10,814 before and 8810 after implementation). In the matched cohort, median waiting time among triage level 1 visits was 11.0 min (IQR, 6.8–17.2) before and 8.2 min (IQR, 5.7–12.5) after implementation; the post-minus-pre difference between subgroup medians was −2.82 min (95% CI, −3.48 to −1.80; p < 0.001). Among triage level 2 visits, medians were 12.4 and 11.8 min, respectively (p = 0.088). Hospital admission and PICU admission or planned admission were more frequent after implementation. Conclusions: The alarm was associated with a shorter median time to documented initial physician evaluation among triage level 1 visits. No statistically significant difference was detected for triage level 2 waiting time in the matched-pair analysis. Residual differences in triage mix and secular trends preclude causal inference.