The Correlation of the Canadian Triage and Acuity Scale (CTAS) on Early Patient Management in the Ambulatory Unit of King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia

Abstract

Aim: This study examined the association between nurses’ knowledge of the Canadian Triage and Acuity Scale (CTAS), self-reported compliance with CTAS protocols, and early patient management outcomes at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Study Design: A convergent mixed-methods design was used. Place and Duration of Study: Data were collected from the Emergency Department and the Family Medicine Department Ambulatory Unit between February and March 2026. Methodology: Quantitative data were obtained from 108 registered nurses using a 10-item CTAS Knowledge Assessment and a 20-item Theory of Planned Behavior-based compliance survey. A retrospective audit of 284 patient records was also conducted to assess door-to-provider and assessment-to-intervention times across CTAS levels. Qualitative data were collected through semi-structured interviews with 11 nurses to explore experiences, perceived barriers, and suggestions related to CTAS use. Quantitative data were analysed using descriptive statistics, Spearman’s rank correlation, the Kruskal-Wallis H test, and Dunn’s post hoc comparisons. Qualitative data were analysed thematically. Results: The mean CTAS knowledge score was 8.39 out of 10 (SD = 2.14), with 64.8% of nurses demonstrating high proficiency. Knowledge was lowest for paediatric laceration and mild respiratory presentations. Self-reported compliance was very high (mean = 4.58, SD = 0.59). CTAS level was significantly associated with door-to-provider time, which increased from Level 1 (mean = 4.95 minutes) to Level 5 (mean = 65.63 minutes), χ²(4) = 225.0, p < .001. No significant positive correlation was found between CTAS knowledge and compliance dimensions. Qualitative findings identified training gaps, high patient volume, resource limitations, language barriers, and interdisciplinary challenges as key factors affecting CTAS implementation. Conclusion: CTAS supported acuity-based prioritisation of patients, but knowledge alone did not explain compliance. Strengthening competency-based training, workflow support, and interdisciplinary coordination may improve CTAS implementation.