From the Guidelines
The Emergency Severity Index (ESI) triage development strategy should utilize a 5-level system, as recommended by the Emergency Nurses Association and the American College of Emergency Physicians, to prioritize patients based on acuity and resource needs. This approach is supported by a study published in the journal Stroke in 2009 1, which highlights the importance of rapid assessment and treatment of stroke patients. The ESI system categorizes patients into five levels, with Level 1 being immediate life threats, Level 2 being high-risk situations, and so on.
Key Components of ESI Triage Development Strategy
- Train emergency department staff in the standardized ESI algorithm, focusing on critical decision points
- Establish clear vital sign danger zones for adults and pediatric patients to trigger upgrades in triage levels
- Implement a phased approach to training, including classroom education, supervised practice cases, competency validation, and regular inter-rater reliability assessments
- Develop standardized documentation templates in the electronic health record to ensure consistent application
- Monitor key performance indicators, including door-to-provider times, left-without-being-seen rates, and admission rates by ESI level
Implementation and Maintenance
- Use a structured approach to improve patient outcomes by ensuring the most critical patients receive immediate attention while appropriately allocating resources based on clinical needs
- Regular case reviews and quarterly refresher training maintain consistency and ensure that staff are up-to-date on the latest ESI guidelines, as recommended by the American Heart Association 1
- The ESI system has been shown to be effective in reducing wait times and improving emergency department flow, ultimately leading to better patient outcomes and reduced morbidity and mortality.
From the Research
Emergency Severity Index (ESI) Triage Development Strategy
The ESI triage system is a five-level emergency department triage algorithm that provides stratification of patients on the basis of acuity and resource needs, being ESI-1 the highest acuity and ESI-5 the lesser 2.
Key Components of ESI Triage Development Strategy
- The ESI version 3 is a five-level triage acuity scale with demonstrated reliability and validity, where patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity) 3.
- Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes 3.
- The ESI triage system was developed to promote quality triage and reliability, and its implementation can lead to improved patient outcomes and reduced waiting times 4, 5.
ESI Triage Development Strategy Implementation
- The implementation of the ESI triage system requires a structured approach, including the development of policies and procedures to guide the triage process 5.
- The majority of emergency departments do not meet the minimum recommendations of the ESI triage system, highlighting the need for improved implementation and adherence to guidelines 5.
- Significant positive relationships were found when an emergency department had structure (policy) to guide process (procedures), emphasizing the importance of a well-structured approach to ESI triage development 5.
Evaluation of ESI Triage Development Strategy
- Studies have evaluated the effectiveness of the ESI triage system, including its ability to predict patient outcomes and reduce waiting times 4, 6.
- The five-level triage system using the ESI has been shown to have high accuracy in triage and estimates patient outcomes effectively, making it a useful tool in hospital triage 6.
- The ESI triage system has been compared to other triage systems, such as the spot check triage, and has been found to be more effective in improving some indicators of emergency and performance indices 4.