EMERGENCY
SEVERITY INDEX
(ESI)
TAUFIQ ABDULLAH
Adapted from the Emergency Severity Index (ESI) Refresher PowerPoint by William Alt, BSN, RN Dayle Ann McCary, MSN, RN, CEN
Emergency Severity Index (ESI)
ESI is a five-level triage scale developed by ED physicians and nurses
Provides a reliable, valid tool for determination of acuity
Describes parameters for the rapid identification of those who need
immediate care
Discriminates between patients that need to be seen emergently versus
urgently
Improves patient flow based on rapid sorting with projected resource and
operational needs
Get the right patient to right resources in the right place
at the right time
Institute of Medicine (IOM)Aims
Safety
Avoiding injuries from care that is intended to help
Effectiveness
Providing services based on evidence and avoiding interventions not likely to benefit
Patient-Centeredness
Respectful and responsive to individual patient preferences, needs, values, in clinical
decision making
Timeliness
Reducing waits and sometimes harmful delays for those who receive care
Efficiency
Avoiding waste, in particular of equipment, supplies, ideas, energy
Equitable Care
Care that does not vary in quality due to personal characteristics (gender, ethnicity,
geographic location, or socio-economic status)
ESI Triage Algorithm
Decisions are based on 4 key questions:
[Link] this patient dying?
[Link] this a patient who shouldn't wait?
[Link] many resources are needed?
[Link] are the vital signs?
ESI TRIAGE ALGORITHM
Decision Point Review
A. Determine if immediate life-saving intervention is required.
B. Is this a High risk situation? For example…
Is the patient confused or disoriented?
Is the patient in severe pain?
C. Consider the resources that the patient will require.
D. Review Vital Signs. Are they Danger Zone Vital Signs?: Consider triaging up to
ESI 2 if any vital signs are beyond patient’s normal parameters.
Adult:
HR >100
RR >20
Sa02 < 92% with clinically significant symptoms
RESOURCES NOT RESOURCES
Labs (blood, urine)
History and physical (including pelvic)
EKG, X-rays,
Point of Care Testing
Saline or heplock
CT,MRI, Ultrasound,
PO Meds
angiography
Tetanus Immunization
IV Fluids (Hydration)
Prescription Refills
IV, IM, nebulized medication
Phone Call to PCP
Specialty consultation
Simple Wound Care
Simple procedure = 1 (dressings, recheck)
(Laceration repair, Foley cath)
Complex procedure =
Crutches, splints, slings
(Conscious Sedation
SUMMARY
Level 1 Resuscitation: Highest Priority
◦ Requires immediate life-saving interventions
◦ Is unresponsive
◦ May include suspected CVA with symptom onset < 3 hours
Level 2 Emergent : High risk situation
◦ Severe pain/distress, or
◦ Acute confusion, lethargy or disorientation
-----------------------------------------------------------------------------------------------------------------
Level 3 Urgent :
◦ Requires 2 or more resources as defined by Emergency Severity Index
Level 4 Less Urgent:
◦ Requires 1 resource as defined by Emergency Severity Index
Level 5 Non-Urgent: Lowest priority to be seen
◦ No resources required as defined by Emergency Severity Index
Levels 1 and 2 based on acuity
Levels 3, 4 and 5 based on anticipated resources
REFERENCES
Gilboy, N., Tanabe. P, Travers DA, Rosenau, A.M., Eitel, D.R.
Emergency Severity Index, Version 4: Implementation Handbook.
AHRQ Publication No. 05-0046-2. Rockville, MD: Agency for
Healthcare Research and Quality. May 2005.
Alt, W. and McCary, D.A. Emergency Severity Index (ESI)
Refresher. 2013
Pediatric Triage PCTAS
There are three things that must be
assessed and documented on all
pediatric patients:
◦ Respiratory rate.
◦ Heart rate.
◦ Capillary refill.
Pediatric CTAS
Poster Pocket Card
Pediatric Vital Signs
Must include:
◦ Heart rate.
◦ Blood pressure.
◦ Respiratory rate.
◦ O2 saturation.
◦ Temperature.
◦ Capillary refill.
◦ Accurate weight!
Pediatric Vital Signs
Vitals Are Your Safety Net.
Less
Urgent and Non Urgent patients have
NORMAL vital signs.
Abnormal vital signs are at least an
URGENT.
General Approach to
POISONED Patient
ABCs…IV, O2, monitor
◦ Decontaminate if organophosphates prior touching by
health care professionals
◦ Lily kit for cyanide poisoning.
History
◦ Obtain all prescription and bottles in the household
(call pharmacy).
◦ Pill count.
◦ PM Hx.
◦ Search clothes for clues, medication alerts, pills etc.
◦ Contact family members.
◦ Track marks, consider body packing or stuffing.
Vital signs, Rhythm strip.
General approach to poisoned
pt.
What are the essential features of a
30-second toxicological exam?
◦ Vital signs- HR, RR, BP.
◦ Temperature- rectal
(resp rate can affect oral temperature).
◦ Skin- color, temperature, and sweating.
◦ Odors- provide clues
(their absence means nothing)
◦ Bowel sounds and bladder function.
◦ Mental status.
General approach to poisoned
pt
Tests
GI Decontamination
◦ Activated Charcoal
Antidotes
QUESTIONS????
