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Refining Emergency Severity Index triage criteria.
Paula Tanabe1, Debbie Travers, Nicki Gilboy
1Department of Emergency Medicine, Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, IL, USA. p-tanabe@northwestern.edu
Summary
The Emergency Severity Index (ESI) can be improved. Some ESI level 2 patients need immediate care, suggesting revisions to ESI level 1 criteria could better identify the sickest patients.
Area of Science:
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- The Emergency Severity Index (ESI) version 3 is a validated 5-level triage tool.
- Clinical observations suggest a need to differentiate between ESI level 2 patients requiring immediate intervention and those who can wait.
- Current ESI level 1 criteria may under-identify the sickest patients.
Purpose of the Study:
- To identify Emergency Severity Index (ESI) level 2 patients who could potentially be reclassified as ESI level 1.
- To determine specific clinical findings that predict the need for immediate intervention in ESI level 2 patients.
Main Methods:
- A multisite, prospective study was conducted.
- ESI level 2 patients requiring immediate, lifesaving intervention were identified.
- Statistical analyses (chi-square, odds ratios) were used to identify predictors of immediate intervention.
Main Results:
- Immediate lifesaving interventions were given to 20.2% of 589 ESI level 2 patients.
- Seventeen predictors for immediate intervention were identified.
- Triage nurse's judgment, particularly regarding airway and medications, was the strongest predictor.
Conclusions:
- Specific triage findings in some ESI level 2 patients correlate with the need for immediate lifesaving interventions.
- Revising the ESI level 1 criteria may improve patient acuity classification and resource allocation.