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Understanding the ED triage process

People in Seattle may hear stories about patients dying in emergency department waiting rooms and worry that they might face the same scenario were they to present to the hospital in an emergent event. Many have developed a “first come, first serve” mentality when it comes to waiting for services (including health care). However, visits to the ED are not supposed to work the same way. Of the 130.4 million ED visits that the Center for Disease Control and Prevention reports occur annually, it may be reasonable to assume that not each of those share the same level of acuity. So how are ED providers to determine who should be seen first?

According to the Agency for Healthcare Research and Quality, an emergency severity index is used during the ED triage process. The index dictates the decision-making of ED triage nurses in order to assign an appropriate level of acuity to patients. The ESI triage process proceeds as follows:

  •          Does the patient require immediate life-saving intervention? If so, he or she needs to be seen immediately.
  •          Is the patient in a high-risk situation, feeling confused, lethargic or disoriented, or experiencing severe pain or distress? If so, then he or she should be placed in the next available ED bed.
  •          How many resources are needed to deliver care? Vital signs are included in these resources, the results of which could bump one up to a higher severity index.

In this case, resources include lab work, imaging studies, hydration services or a consultation.

The ESI assigns values on a 1-5 scale, with 1 being the highest level of acuity. One should never expect to see a patient with an ESI score of 1 or 2 to be seen after a case on the lower end of the spectrum.

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