Function of triage
Triage is an essential function underpinning the delivery of care in all EDs, where any number of people with a range of conditions may present at the same time. Although triage systems may function in slightly different ways according to a number of local factors, effective triage systems share the following important features: 5
• A single entry point for all incoming patients( ambulant and non-ambulant), so that all patients are subjected to the same assessment process.
• A physical environment that is suitable for undertaking a brief assessment. It needs to include easy access to patients which balances clinical, security and administrative requirements, and the availability of first aid equipment and hand-washing facilities.
• An organised patient processing system that enables easy flow of patient information from point of triage through to ED assessment, treatment and disposition.
• Timely data on ED activity levels, including systems for notifying the department of incoming patients from ambulance and other emergency services.
Emergency triage scales
Internationally, five-tier triage scales have been shown to be a valid and reliable method for categorising people who are seeking assessment and treatment in hospital EDs. 11-22 These scales show a greater degree of precision and reliability when compared with either three-tier 23 or four-tier triage systems. 3
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The features of a robust triage system can be evaluated according to the following four criteria:
• Utility: The scale must be relatively easy to understand and simple to apply by emergency nurses and physicians.
• Validity: The scale should measure what it is designed to measure; that is, it should measure clinical urgency as opposed to severity or complexity of illness or some other aspect of the presentation or of the emergency environment.
• Reliability: The application of the scale must be independent of the nurse or physician performing the role, that is, it should be consistent.‘ Inter-rater reliability’ is the term used for the statistical measure of agreement that is achieved by two or more raters using the same scale. 24
• Safety: Triage decisions must be commensurate with objective clinical criteria and must optimise time to medical intervention. In addition, triage scales must be sensitive enough to capture novel presentations of high acuity. 3
The Australasian Triage Scale( ATS), formerly the National Triage Scale( NTS)
The National Triage Scale( NTS) was implemented in 1993, becoming the first triage system to be used in all publicly funded EDs throughout Australia. In the late 1990s, the NTS underwent refinement and was subsequently renamed the Australasian Triage Scale( ATS).
Department of Health and Ageing – Emergency Triage Education Kit