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

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Preface This handbook is intended only as a guide to using the ESI system for categorizing patients at triage in ED settings. Nurses who participate in an ESI educational program are expected to be experienced triage nurses and/or to have attended a separate, comprehensive triage educational program. This handbook is not a comprehensive triage educational program. The ESI educational materials in this handbook are best used in conjunction with a triage educational program. Triage nurses also need education in institution-specific triage policies and protocols. For example, hospitals may develop policies regarding which types of patients can be triaged to fast-track. Triage protocols may also be developed, such as giving acetaminophen for fever, or ordering ankle films for patients who meet specified criteria. vi
Contents Chapter 1. Introduction to the Emergency Severity Index: A Research-Based Triage Tool .........................1 Chapter 2. Overview of the Emergency Severity Index.................................................................................7 Chapter 3. ESI Level 2 ...................................................................................................................................17 Chapter 4. ESI Levels 3-5 and Expected Resource Needs.............................................................................29 Chapter 5. The Role of Vital Signs in ESI Triage..........................................................................................35 Chapter 6. The Use of ESI for Pediatric Triage .............................................................................................41 Chapter 7. Implementation of ESI Triage.....................................................................................................53 Chapter 8. Evaluation and Quality Improvement.......................................................................................63 Chapter 9. Practice Cases ..............................................................................................................................71 Chapter 10. Competency Cases......................................................................................................................85 Appendixes Appendix A. Frequently Asked Questions and Post-Test Materials for Chapters 2-8.........................................................................................................................A-1 Appendix B. ESI Triage Algorithm Version 4.................................................................................................B-1 Appendix C. Abbreviations and Acronyms ...................................................................................................C-1 vii
Page 1 and 2: Emergency Severity Index (ESI) A Tr
Page 3 and 4: Emergency Severity Index (ESI) A Tr
Page 5 and 6: Note From the Director The Agency f
Page 7: Preface The Emergency Severity Inde
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
Page 55 and 56: ESI Level 2 As with assigning an ES
Page 57 and 58: 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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