Content
Philosophy
The philosophy underpinning the use of the ATS is based on the values of justice and efficiency in health service delivery. 4, 17 The ATS has been designed to provide a timely assessment and medical intervention for all people who present to an ED. Implicit within this framework is the principle that it is neither clinically or ethically appropriate to expect any group of people to routinely wait longer than two hours for medical care in an ED. 1
Development
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FitzGerald( 1989) first tested the validity and reliability of the Ipswich Triage Scale( ITS), which was an adaptation of the Box Hill Hospital System. He examined correlations between triage codes and outcome measures, including in-hospital mortality and admission rates. Informed by this original work, the development and implementation of the National Triage Scale( NTS) throughout Australia occurred in 1993.
The subsequent implementation of the ATS was supported by a process of consultation by the Commonwealth Department of Health and Family Services with clinicians and key professional bodies throughout Australasia. Research by Whitby, Leraci et al.( 1997) was used in the ATS to describe the clinical features associated with urgency and to develop more comprehensive descriptions of each of the five triage categories.
Within the ATS framework, urgency is a function of both the patient’ s clinical risk and the severity of their symptoms. The strength of the ATS lies in its use of physiological descriptors to tier common complaints into the appropriate triage category. This approach can enhance decision-making by reducing the time taken to determine a triage code. 3
A comprehensive explanation of the ATS, and the descriptors for each of the ATS categories, are provided in Appendix B.
Application
The application of the ATS is underpinned by the formulation of a chief complaint, which is identified from a brief history of the presenting illness or injury. Triage decisions using the scale are made on the basis of observation of general appearance, focused clinical history and physiological data. Clinicians who undertake the role must have experience in the assessment of a wide range of illness and injury. They must also meet organisational requirements to undertake the role. An assessment of their suitability for the role should also be judged on the individual’ s ability to consistently and independently make sound clinical decisions in a time-pressured environment. 32
Department of Health and Ageing – Emergency Triage Education Kit