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Updated: Jun 2, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Mandatory triage does not identify high-acuity patients within recommended time frames.

Ellen J Weber¹, Ian McAlpine, Barbara Grimes

¹Department of Emergency Medicine, University of California-San Francisco, CA 94143, USA. ellen.weber@ucsf.edu

Annals of Emergency Medicine

|April 26, 2011

Summary

Formal triage in emergency departments (EDs) aims to quickly identify acutely ill patients. However, this study found less than half of high-acuity patients completed triage within recommended times, suggesting potential safety concerns.

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Last Updated: Jun 2, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Area of Science:

Emergency Medicine
Healthcare Systems Analysis
Patient Flow Management

Background:

Emergency departments (EDs) face challenges in managing patient flow and ensuring timely care for acutely ill individuals.
Formal triage systems, such as the Emergency Severity Index (ESI-5), are implemented to prioritize patients based on acuity.
The ESI-5 system recommends immediate or within 10-minute physician treatment for ESI level 1 and 2 patients, respectively.

Purpose of the Study:

To evaluate the effectiveness of mandatory formal triage in emergency departments for the timely recognition of acutely ill patients.
To determine if the current triage process in a busy urban academic ED meets the recommended timeframes for high-acuity patients.

Main Methods:

A retrospective cross-sectional study analyzed data from 3,932 high-acuity (ESI 1 or 2) walk-in patients at a US urban academic ED.
Data were collected from electronic medical records and registration systems for the year 2008.
Key metrics included time from arrival to triage completion, adherence to ESI-5 recommendations, and triage throughput during peak hours.

Main Results:

The median time from arrival to triage completion for high-acuity patients was 12.3 minutes.
Only 41% of high-acuity patients completed triage within the recommended 10 minutes.
Triage completion times were longer during peak arrival hours (10 am to 10 pm), particularly for ESI level 2 patients.

Conclusions:

Mandatory formal triage in this urban ED did not consistently ensure timely care for high-acuity patients, with less than half meeting ESI-5 recommendations.
The study highlights potentially unsafe delays in recognizing and treating the most acutely ill patients.
Reassessment of the value and safety of the current formal triage process is warranted.