1. Emergency Severity Index, Version 4:Implementation Handbook Agency for Healthcare Research and Quality: Pub. No. 05-0046-2, May 2005

2. Triage is derived from the French verbtrier, to sort or choose.Originally the process was used by themilitary to sort soldiers wounded in battlefor the purpose of establishing treatmentpriorities. 3. Emergency Nurses Association (ENA)Standards of Emergency Nursing PracticeThe emergency nurse triages each patient anddetermines the priority of care based onphysical, developmental and psychosocial needsas well as factors influencing access to health careand patient flow through the emergency caresystem.The goal is to rapidly gather sufficient informationto determine triage acuity. (ENA, 1999, p. 23). 4. It is recommended that comprehensive triage is tobe completed in 2 to 5 minutes, Travers (1999)demonstrated at one tertiary center ED that thisgoal was only met 22% of the time. The triage nurse is expected to obtain a completehistory, take vital signs and complete department-specific screening questions. 5. In 2003, the National Center for Health Statisticsfound that 47% of EDs used 3-level triagesystems, while 20% used 4-level and 20% used 5-level systems (personal communication, CatharineBurt, Nov 1, 2004).5-level triage 20%4-level triage 20%3-level triage47% 6. Recent Trends Affecting EDED overcrowding The American Hospital Association (2002)reported 90% of hospital ED perceive they are ator over operating capacity. The average waiting time to be seen by an EP in2001 was 49 minutes, which represented anincrease of 11 minutes from 1997 (McCaig &Ly, 2002). 7. Triage Systems in the United StatesThough many U.S. hospitals still use a 3- or 4-level triage system, the trend is toward the use of5-level systems. Both ENA and the ACEP have come out insupport of 5-level triage systems for U.S. EDs. 8. Triage Systems in the United States3 levels 4 levels5 levels Emergent Life-threatening Resuscitation Urgent Emergent Emergent Nonurgent Urgent Urgent Nonurgent Nonurgent Referred 9. Emergency Severity Index Conceptual Algorithm, v. 4 yes patient dying?1noyes shouldnt wait? 2nohow many resources? nononemanyconsider5 4vital signsnoESI Triage Research Team, 2004. 3 10. 1 requires immediate life-savingyes intervention? nohigh risk situation? yes or confused/lethargic/disoriented? 2or severe pain/distress?nohow many different resources are needed?nononemanyconsider danger zone vitals?54180> 160 >100 RR>50> 40> 20 SaO238.0 C 3 months to 3 yrs of age: consider assigning ESI 3 iftemp >39.0 C, or incomplete immunizations, or noobvious source of fever