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Shifting Urgency: Effects of a Color-Coded Triage System on Operating Room Add-On Case Volume and Acuity
George Bushey1, MD; Clara Sanders1, MD; Edward Kelly1, MD; Nicolas Jabbour1, MD; Avital Carlis1, MPH; Tovy Kamine1, MD 1Baystate Medical Center, Springfield, MA
Background: High-volume tertiary centers manage large numbers of urgent surgical add-on cases, often without a standardized prioritization process. To improve operating room (OR) access and resource allocation, our institution transitioned from a word-based urgency classification system to a six-tier color-coded triage system. Methods: A six-tier color-coded OR triage system was implemented: red (immediate), orange (≤2 hours), yellow (≤6 hours), green (≤12 hours), blue (24–48 hours), and white (2–4 days), reflecting increasing urgency. In this pre-post quality improvement study, outcomes before and after implementation (10/1/2025–6/1/2026) included monthly add-on case volume, acuity distribution, and time from booking to OR. Results: Following implementation, mean monthly add-on case volume decreased by 35%, from 359 to 234 cases (p=0.005). The acuity distribution of add-on cases did not change significantly. Time from booking to OR decreased significantly for red cases (8.4 vs 0.7 hours, p=0.04), orange (89.0 vs 1.8 hours, p<0.005), yellow (72.5 vs 7.6 hours, p<0.005), and green (103.1 vs 21.6 hours, p<0.005). Conclusions: Implementation of a color-coded OR triage system was associated with fewer add-on cases and shorter time from booking to OR. Improved identification and scheduling of lower-acuity cases may enhance prioritization and OR throughput at high-volume tertiary centers.
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