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

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This handbook is dedicated to our leader, collaborator, and friend Dr. Richard Wuerz At the time of his death Dr. Wuerz was an Attending Physician Associate Research Director Department of Emergency Medicine Brigham and Women's Hospital Boston, MA and Assistant Professor of Medicine (Emergency Medicine) Harvard Medical School Boston, MA Suggested Citation: Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12-0014. Rockville, MD. Agency for Healthcare Research and Quality. November 2011. ii
Note From the Director The Agency for Healthcare Research and Quality (AHRQ) is pleased to bring you the Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4: Implementation Handbook, 2012 Edition. This edition of the handbook, like the previous edition, covers all details of the Emergency Severity Index—a fivelevel emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from least to most urgent based on acuity and, unique to ESI, resource needs. This edition introduces a new section (Chapter 6), developed in response to numerous requests for more detailed information on using the ESI algorithm with pediatric populations. The section recognizes that the needs of children in the emergency room differ from the needs of adults, including: • Different physiological and psychological responses to stressors. • More susceptibility to a range of conditions, such as viruses, dehydration, or radiation sickness. • Limited ability to communicate with care providers; thus harder to quickly and accurately assess. In keeping with our mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, one of AHRQ’s areas of emphasis is improved training for the health care workforce. This handbook will provide invaluable assistance to ED nurses, physicians, and administrators in the implementation of a comprehensive ESI educational program. In turn, a well-implemented ESI program will help hospital emergency departments rapidly identify patients in need of immediate attention, and better identify patients who could safely and more efficiently be seen in a fast-track or urgent-care area rather than in the main ED. We hope that you find this tool useful in your ongoing efforts to improve the quality of care provided by your emergency department. Carolyn M. Clancy, M.D. Director Agency for Healthcare Research and Quality iii
Page 1 and 2: Emergency Severity Index (ESI) A Tr
Page 3: Emergency Severity Index (ESI) A Tr
Page 7 and 8: Preface The Emergency Severity Inde
Page 9 and 10: Contents Chapter 1. Introduction to
Page 11 and 12: Chapter 1. Introduction to the Emer
Page 17 and 18: Chapter 2. Overview of the Emergenc
Page 27 and 28: Chapter 3. ESI Level 2 cluster of c
Page 29 and 30: Chapter 3. ESI Level 2 • Sepsis
Page 31 and 32: Chapter 3. ESI Level 2 Toxicologica
Page 33 and 34: Chapter 3. ESI Level 2 Table 3-1. E
Page 35 and 36: Chapter 3. ESI Level 2 2. Is the Pa
Page 37 and 38: Chapter 3. ESI Level 2 References E
Page 39 and 40: Chapter 4. ESI Levels 3-5 and Expec
Page 41 and 42: Chapter 4. ESI Levels 3-5 and Expec
Page 43 and 44: Chapter 5. The Role of Vital Signs
Page 45 and 46: those triaged as ESI level 3. The r
Page 47 and 48: A 72-year-old patient presents to t
Page 49 and 50: Chapter 6. Use of the ESI for Pedia
Page 51 and 52: to the safe care of a child. Method
Page 53 and 54: at triage. Febrile children over th
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ESI Level 2 As with assigning an ES
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Table 6-6. Examples of Pediatric Tr
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Children with Co-Morbid Conditions
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Chapter 7. Implementation of ESI Tr
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The ED leadership team will ultimat
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will help assure reliability and va
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• The patient's rating of pain is
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• E-mails to remind staff of the
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Chapter 8. Evaluation and Quality I
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The cases in this chapter are provi
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28. “I just need another prescrip
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56 EMS arrives with a 42-year-old m
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84. EMS arrives with a 75-year-old
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14. ESI level 2: High risk. A tempe
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46. ESI level 4: One resource. The
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77. ESI level 5. No resources. No r
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Chapter 10. Competency Cases This c
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Set B Competency Cases 1. “Withou
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6. ESI level 2: High risk. Rashes a
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11. ESI level 2: High risk. An over
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Appendix A. Frequently Asked Questi
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Appendix B. ESI Triage Algorithm, v
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Appendix C. Abbreviations and Acron
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Notes: A. Immediate life-saving int
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