Emergency Severity Index Triage Training UNION HOSPITAL EMERGENCY ROOM
What is ESI? • Emergency Severity Index • A five level triage scale that uses prioritization based on urgency (acuity) of condition but also considers resources needed to get the patient thru to ED disposition. • Endorsed by ACEP and ENA.
So, a 5 Level rating? • 5 levels have meaningful differences between each level compared to previous 3 Level systems. • ESI levels can be used to describe acuity levels. Not only # of visits annually but # of each level of patient. • Can be used to justify staffing. • 5 Level is research based, standardized and reliable between users.
Emergency Severity IndexESI • Acuity assessment - Airway, breathing, circulation - Potential for life, organ or limb threat - How soon the patient needs to be seen • Expected resource assessment - Number of resources, as estimated by the triage nurse, that a patient is expected to consume in order for a disposition decision.
Emergency Severity IndexESI • Five explicitly defined categories Mutually exclusive Allows for rapid sorting • Differs from a complete assessment Gathering sufficient information to assign an ESI level Quick sorting
Resource Examples • CBC,BMP, PT/PTT=One Resource • CBC, CXR=Two Resources • CXR, ABD Series=One Resource • CXR,CT Scan=Two Resources • CBC,CT Scan, EKG=Three Resources
Frequently Asked Questions • Why isn’t a splint a resource? The application of a simple, pre-formed splint is not considered a resource. This is not being used to make the disposition decision. The Xray showing the injury makes the dispo decision. • Why are the following considered resources? Eye irrigation, nebulized meds, and blood transfusion. All three are considered resources for the purposes of ESI. They tend to be used on patients that are more acute, require significant ED time, and are likely to have longer LOS.