In emergency settings, triage is the process of rapidly categorizing patients based on the severity of their condition to prioritize care [1], [2]. In line with this, accurate and prompt triage is vital for patient safety, ensuring that critically ill patients receive timely treatment in the emergency department (ED), while those with less severe conditions can wait with assurance. The significance of triage extends beyond mere patient categorization; it substantially impacts patient prognosis by facilitating a reduction in waiting times and optimizing the utilization of resources [3], [4], [5]. However, triage accuracy remains a challenge, with a previous review highlighting that the accuracy of triage varies greatly, ranging from 58.3 % to 82.9 % [6]. This inconsistency underlines the need for continuous triage education to minimize such disparities [6].

The triage scale is included in triage education given that triage involves the evaluation of a patient’s health condition by a triage officer, who then grades the patient according to the triage scale. Different scales have been devised to enhance the effectiveness of triage, each of which is tailored to the unique healthcare environments of their respective countries. Globally, a five-level triage system is typically adopted, with renowned triage scales including the Emergency Severity Index (ESI) in the United States, the Canadian Triage and Acuity Scale (CTAS) in Canada, the Manchester Triage System (MTS) in the United Kingdom, and the Australasian Triage Scale (ATS) in Australia [7]. These scales have served as foundational models for the creation of new scales across various countries; for example, in Korea, the Korean Triage and Acuity Scale (KTAS) was formulated using the CTAS as a reference [8]. In Korea, given that the KTAS is a relatively recent development [8], there is a pressing need for concerted efforts toward the development and establishment of diverse, effective, and accessible educational programs to ensure proficiency in its application.

Triage education has seen a variety of instructional approaches, with recent trends gravitating towards digital, gamified, and blended learning methodologies [9], [10], [11], [12]. Gamification is one such emerging approach in this domain, which involves the integration of game-design elements into non-gaming contexts, such as education [13]. Gamification has the potential to make learning more interactive and engaging, which drives motivation and enhances knowledge retention [14], [15], [16]. Techniques of gamification may include the incorporation of challenges, levels, rewards, leaderboards, and storylines, all of which induce a sense of achievement, competition, and motivation among learners [13], [15], [16], [17]. However, few studies have attempted to introduce gamification into ED triage training for doctors, and those that have reported reductions in undertriage and increases in accuracy [18], [19]. Moreover, an attempt was made to introduce gamification into the ED triage targeting nurses, but the evidence for improving the accuracy of the triage was unclear [12]. As nurses are primarily responsible for triage in the EDs [1], [20], it is vital to develop a program that fosters engagement and interest among learners, allowing for continuous participation in education. To this end, we developed a Game-Based Triage Educational App (GTEA) by combining the convenience of digital learning with gamification elements, with the aim to improve classification accuracy for emergency nurses. Therefore, the purpose of this study was to evaluate the effectiveness of the GTEA as a learning tool for emergency nurses using the KTAS, with a focus on creating an engaging and effective triage education platform. In this study, we hypothesized that emergency nurses, after utilizing GTEA, would exhibit improved 1) triage accuracy (primary outcome) compared to before its use, and 2) enhancements in critical thinking disposition, triage competency, and triage knowledge (secondary outcomes).