Predicting Pediatric Emergency Severity Index Level Based on Emergency Department Pre-Arrival Information

This study examines the use of phone referral information to predict Emergency Severity Index triage levels as a proxy to anticipate emergency department nursing resource allocation in a pediatric hospital. It also assesses the relationship between these pre-arrival triage levels and hospital admission.

Emergency nurses with specialized training used standardized phone referral information to assign triage levels to 481 patients before their arrival. Upon patient arrival, independent triage levels were assigned. The two levels were then compared and patient disposition was collected. Descriptive statistics and Cohen's kappa were used to assess agreement between the two emergency severity index levels.

Moderate agreement was found between the pre-arrival and arrival triage levels. The majority of patients (71.3%) with a pre-arrival triage level of 1 or 2 (the most acute levels) were admitted to the hospital. These patients were also more likely to be admitted to the intensive care unit than were patients with a pre-arrival triage level≥3.

The ability to predict triage levels for incoming patients could give the emergency department charge nurse the ability to plan ahead so that appropriate nursing staffing is available upon arrival. The knowledge that patients assigned a pre-arrival triage level of 1 or 2 are more likely to be admitted gives the emergency department the ability to plan for bed placement and inpatient nursing resources earlier, potentially resulting in decreased emergency department length of stay. More study on these potential benefits is needed.