Scoping Review of the Canadian Triage and Acuity Scale (CTAS) Implementation, Reliability, Challenges, and Impact in Saudi Arabian Emergency Departments

Khalid Abdullah S Alharbi, Faridah Mohd Said

Abstract

Background: Emergency department overcrowding and increasing patient demand highlight the need for reliable triage systems to prioritize patients according to clinical urgency. The Canadian Triage and Acuity Scale (CTAS) has been implemented in Saudi Arabian emergency departments, but evidence regarding its reliability, implementation, challenges, and operational impact remains fragmented. Methods: A scoping review was conducted following the Arksey and O’Malley framework, subsequent recommendations by Levac et al., Joanna Briggs Institute guidance, and PRISMA-ScR reporting standards. Literature was searched in PubMed, MEDLINE, CINAHL, Scopus, Web of Science, Google Scholar, Saudi Medical Journal, Eastern Mediterranean Health Journal, and Saudi Ministry of Health publications for studies published from January 2015 to March 2026. Eligible studies examined CTAS implementation in Saudi Arabian emergency departments or urgent care settings. Data were synthesized using descriptive numerical and thematic analyses. Results: Thirteen studies were included from 1,134 identified records. CTAS demonstrated good to excellent inter-rater reliability, with Cohen’s kappa coefficients ranging from 0.77 to 0.87. Implementation was associated with reductions in emergency department waiting times of approximately 40–50% in some institutions. However, 42–75% of visits were classified as non-urgent (CTAS Levels IV–V), contributing to persistent overcrowding. Digital CTAS improved documentation and workflow, while training and competency-based education improved nurses’ triage accuracy. Key challenges included workforce shortages, inadequate training, technological limitations, inconsistent implementation, and limited public awareness. Conclusion: CTAS is a reliable and effective triage system in Saudi Arabian emergency departments. National standardization, continuous professional education, digital infrastructure, stronger primary healthcare integration, and public education are recommended to improve emergency care efficiency in alignment with Saudi Vision 2030.

Keywords

Canadian Triage and Acuity Scale (CTAS); Saudi Arabia; Emergency Department; Triage Reliability; Overcrowding

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References

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DOI: http://dx.doi.org/10.25157/ihc.v2i1.26457

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