Emergency Severity Index( ESI)
The Emergency Severity Index( ESI) is a system of triage categorisation that is based on both treatment acuity( How soon should a patient be seen?) and resource consumption( What resources is the patient likely to require?). The ESI has been refined on a number of occasions. 21, 22, 26 It has been found to be reliable when tested using written case scenarios, 21 and is currently being considered for use across the United States of America. 24
The triage role
Triage decision-making is an inherently complex and dynamic process. Decisions are made within a time-sensitive environment, with limited information, for patients who generally do not have a medical diagnosis. Due to the multifaceted nature of the triage role, nurses are required to possess specialised knowledge as well as experience with a wide range of illness and injuries. Triage decisions can be divided into primary and secondary categories according to the aims of the triage system. Understanding these decision types is helpful in describing the roles and responsibilities of the Triage Nurse in actual practice.
‘ Primary triage decisions’ relate to the establishment of a chief complaint and the allocation of urgency. When a triage code is selected there are three possible outcomes:
•‘ Under-triage’ in which the patient receives a triage code that is lower than their true level of urgency( as determined by objective clinical and physiological indicators). This decision has the potential to result in a prolonged waiting time to
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medical intervention for the patient and risks an adverse outcome.
•‘ Correct( or expected) triage decision’ in which the patient receives a triage code that is commensurate with their true level of urgency( as determined by objective clinical and physiological indicators). This decision optimises time to medical
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intervention for the patient and limits the risk of an adverse outcome.
•‘ Over-triage’ in which the patient receives a triage code that is higher than their true level of urgency. This decision has the potential to result in a shortened waiting time to medical intervention for the patient, however, it risks an adverse outcome for other patients waiting to be seen in the ED because they have to wait longer.
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The Triage Nurse makes urgency decisions using clinical and historical information to avoid systematic under- or over-triage.‘ Secondary triage decisions’ are concerned with expediting emergency care and disposition. 28, 29 The Triage Nurse employs locally based policies and procedure to expedite care for all patients where appropriate.
All patients in the waiting room must be reassessed by the Triage Nurse once the triage time has expired. This second assessment should always be documented in the patient’ s notes. 6
Department of Health and Ageing – Emergency Triage Education Kit