Emergency Severity Index (ESI): A Triage Tool for Emergency ...

headache treatment. ESI level-3 patients triaged to
UC and all patients sent to the acute area from UC
for more serious conditions are monitored in the
quality improvement program. Nurses using the ESI
have reported that the tool facilitates
communication of patient acuity more effectively
than the former three-level triage scales used at the
sites (Wuerz et al., 2001). For example, the triage
nurse can tell the charge nurse, "I need a bed for a
level-2 patient," and through this common
language, the charge nurse understands what is
needed without a detailed explanation of the
patient by the triage nurse. Hospital administrators
can use the case mix in real time to help make
decisions regarding the need for additional resources
or possibly diverting ambulance arrivals. If a waiting
room has multiple level-2 patients with long waits,
the hospital may need to develop a plan for the
disposition of those patients who are waiting for an
inpatient bed and occupying space in the ED.
The ESI also has been used as the foundation for ED
policies that address specific populations. For
example, the psychiatric service at one site is
expected to provide consults for level-2 and level-3
patients with psychiatric complaints within 30
minutes of notification and for level-4 and level-5
patients within 1 hour. At another site, the ESI has
been incorporated into a policy for patients greater
than 20 weeks pregnant who present to the ED.
Patients rated at ESI levels 1 and 2 are treated in the
ED by emergency medicine with an obstetrical
consult. Those rated 3, 4, or 5 are triaged to the
labor and delivery area of the hospital.
Standardization of ED triage acuity data using the
ESI is beneficial for secondary uses of ED data. For
example, ED crowding researchers have
incorporated the ESI into metrics for measuring and
predicting ED crowding (Bernstein, Verghese, Leung,
Lunney, Perez, 2003). Wider adoption of the ESI by
U.S. hospitals could lead to the establishment of a
true standard for triage acuity assessment, which
will facilitate benchmarking, public health
surveillance, and research.
References
American College of Emergency Physicians (2010). ACEP
policy statements: Triage scale standardization. Dallas,
TX: American College of Emergency Physicians.
Retrieved June 1, 2011, from http://www.acep.org/
Content.aspx?id=29828&terms=triage%scale.
Chapter 1. Introduction to the Emergency Severity Index: A Research-Based Triage Tool
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