Decreasing triage time: effects of implementing a step-wise ESI algorithm in an EHR†

Villa, Stephen; Weber, Ellen J; Polevoi, Steven K.; Fee, Christopher; Maruoka, Andrew; Quon, Tina

doi:10.1093/intqhc/mzy056

Cited by 6 publications

(3 citation statements)

References 10 publications

(12 reference statements)

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“…[ 13 ] Some studies indicated that the average duration of triage is 2.6 ± 2.5,[ 14 ] and 5.9 minutes. [ 15 ] In another study, it was found that the longest time period allocated for triage was in category three patients at 2.8 ± 2.5 min. [ 14 ] The literature suggests that triage assessment should be performed between 2 and 5 min in order for the assessment to be fast and accurate.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the accuracy of nurse triage in tertiary care emergency departments

et al. 2020

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OBJECTIVES: The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department. METHODS: This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00. RESULTS: The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% ( n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts ( P < 0.05). CONCLUSIONS: The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients.

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Section: Discussionmentioning

confidence: 99%

Factors affecting the accuracy of nurse triage in tertiary care emergency departments

et al. 2020

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“…There are various approaches that aim to improve coordination of ED care by reducing time for triage, treatment and transfer of patients. [25][26][27][28] Our work suggests that ESI might be a promising tool to improve coordination of care by predicting type and amount of hospital beds required for specific ED patient groups. Patients with symptoms pointing at neurological problems need particular attention as ESI failed to sufficiently predict the care facility level needed in this patient group.…”

Section: Discussionmentioning

confidence: 99%

Patient disposition using the Emergency Severity Index: a retrospective observational study at an interdisciplinary emergency department

et al. 2022

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ObjectivesEarly patient disposition is crucial to prevent crowding in emergency departments (EDs). Our study aimed to characterise the need of in-house resources for patients treated in the ED according to the Emergency Severity Index (ESI) and the presenting complaint at the timepoint of triage.DesignA retrospective single-centre study was conducted.SettingData of all patients who presented to the interdisciplinary ED of a tertiary care hospital in Munich, Germany, from 2014 to 2017 were analysed.Participantsn=113 694 patients were included.MeasuresESI Score, medical speciality according to the chief complaint, mode of arrival, admission rates and discharge destination from the ED were evaluated.ResultsPatient disposition varied according to ESI scores in combination with the chief complaint. Patients with low ESI scores were more likely to be admitted after treatment in the ED than patients with high ESI scores. Highly prioritised patients (ESI 1) mainly required admission to an intensive care unit (ICU, 27%), intermediate care unit (IMC, 37%) or immediate intervention (11%). In this critical patient group, 30% of patients with neurological or medical symptoms required immediate intensive care, whereas only 17% of patients with surgical problems were admitted to an ICU. A significant number of patients (particularly with neurological or medical problems) required hospital (and in some cases even ICU or IMC) admission despite high ESI scores.ConclusionsOverall, ESI seems to be a useful tool to anticipate the need for specialised in-hospital resources on arrival. Patients with symptoms pointing at neurological or medical problems need particular attention as ESI may fail to sufficiently predict the care facility level for this patient group.

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“…One important result of our analysis was the discordance between ED-assigned acuity and ophthalmologyassigned acuity in patients with an ocular complaint as the primary diagnosis. ED-assigned acuity status can be used to derive quality statistics or set hospital policy regarding consultations 6,7 . Our data demonstrate that retrospective ophthalmology-assigned acuity was somewhat discordant from ED-assigned acuity, particularly on the extremes of the ED Severity Index.…”

Section: Discussionmentioning

confidence: 99%

A summary of eye-related visits to a tertiary emergency department

Rai

Mehta

Larochelle

et al. 2021

Sci Rep

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Timely ophthalmologic consultation is important to ensure patients receive high quality ophthalmologic care in the Emergency Department (ED). Tele-ophthalmology may prove useful in safely and efficiently managing ED eye-related complaints. Prior to implementing such a solution, current consultation patterns must be understood. We aimed to assess case-mix acuity and consultation workflow patterns in the ophthalmology consult service at a tertiary emergency department in New York City. The medical records of patients with eye-related complaints who presented to the ED between January 1, 2015 and December 31, 2015 were reviewed. Visits were retrospectively assigned acuities and the ophthalmologic subspecialty involved in the case was recorded. The number of ophthalmologic consultations ordered and consultant response times were analyzed. Patients who were transferred to the ED for eye-related complaints were included. The ED received 1090 eye-related complaints in this period. 60% were retrospectively assigned low acuity, 27% were assigned medium acuity, and 13% were assigned high acuity. Ophthalmology was consulted on 19% of low, 18% of medium, and 48% of high acuity cases. 44% of complaints involved the anterior segment and 30% involved oculoplastics. 2/3 of transfer patients initially assigned high acuity were downgraded to low acuity upon examination. On average, the consult note was created and signed within 109 and 153 min, respectively, after consult order. ED consults are heavily weighted towards pathology of low-to-medium acuity affecting the anterior segment and ocular adnexa. Currently available tele-ophthalmology technology can potentially address a large volume of eye-related visits.

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Decreasing triage time: effects of implementing a step-wise ESI algorithm in an EHR†

Abstract: The computerized triage scale improved speed of triage, allowing more high acuity patients to be seen within recommended timeframes, without notable impact on quality.

Cited by 6 publications

References 10 publications

Factors affecting the accuracy of nurse triage in tertiary care emergency departments

Factors affecting the accuracy of nurse triage in tertiary care emergency departments

Patient disposition using the Emergency Severity Index: a retrospective observational study at an interdisciplinary emergency department

A summary of eye-related visits to a tertiary emergency department

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