More Patients Are Triaged Using the Emergency Severity Index Than Any Other Triage Acuity System in the United States

Abstract

Objectives: Patient acuity triage systems can play an important role in supporting patient safety and emergency department (ED) operations. In 2003, the boards of the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) approved a joint statement calling for hospitals to adopt a reliable, valid, five-level triage scale such as the Emergency Severity Index (ESI). Still, there appears to be considerable variation in use of triage acuity systems in the United States, with many hospitals using three-and four-level systems that have not been validated. The purpose of this effort was to measure the use of various triage acuity systems in U.S. hospitals. Methods:The authors conducted a cross-sectional analysis of secondary data. Data were obtained from the 2009 American Hospital Association (AHA) Annual Survey-an intensive questionnaire mailed to all U.S. general medical and surgical hospitals. In 2009, a question was added to the survey about hospitals' use of triage systems in EDs. Descriptive statistics were used to explore various triage acuity systems used by different types of hospitals.Results: Of the 4,897 hospitals surveyed, 82% responded, and 62% (3,024 hospitals) provided information on their ED triage system. The 2009 data revealed that the most commonly used triage system types were the five-level ESI (56.9% of responding hospitals) and three-level triage systems (25.2%). More than 70% of large hospitals and teaching hospitals use the ESI, and the unvalidated three-level systems were more common in small hospitals, public hospitals, nonteaching hospitals, and hospitals in the Midwest. The majority (72.1%) of all ED patient visits to hospitals in our sample were assessed using ESI; only 13.1% of visits were assessed using a three-level system.Conclusions: Among our sample of more than 3,000 hospitals, the ESI was the most commonly used triage system, and more patients were triaged using the ESI than any other triage acuity system. Still, there is an opportunity to further promote the adoption of validated, reliable triage systems.

Évaluation de la classification infirmière des malades aux urgences (CIMU) : généralisation des résultats

“…Le triage en structure des urgences (SU) a fait l'objet de recommandations en 2012 sous l'égide de la Société française de médecine d'urgence [1]. Bien que des échelles de triage à trois niveaux soient encore utilisées [2], les échelles à cinq niveaux comme la classification infirmière des malades aux urgences (CIMU) semblent supérieures en termes de reproductibilité et d'exactitude [3][4][5].…”

Emergency severity index version 4 during the first year of implementation at an academic institution

“…[8] It is the most widely used triage system in the United States and is becoming more widely used in other non English speaking countries. [9,10] There are many other five level ED triage systems used worldwide including the Manchester Triage System (MTS), the Canadian Triage and Acuity Scale (CTAS), the Australasian Triage Scale (ATS), among other multi level informal systems. [5,[11][12][13] In both the ATS and CTAS system, each level has a time goal to initiation of medical evaluation.…”

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

“…[15][16][17][18][19] A survey carried out in US in 4897 hospitals showed that there is no triage system in 0.7% of emergency departments, a 2-level triage system in 0.3%, a 3-level triage system in 25.2%, a 4-level triage system in 9.6%, a 5-level ESI triage system in 56.9%, another 5-level triage system in 6.3%, and other triage system in 0.1% of emergency departments. [20] It was also shown that the triage level application has changed according to the number of incoming patients; while 5-level ESI triage system applied in 78.3% of crowded emergency departments having more than 100.000 or more annual urgent patients, 3-level triage system has been applied in 60.2% of the emergency departments having less than 1.000 annual urgent patients. [20,21] As suggested in the statement published in 2009 by the Ministry of Health of Turkish Government, the 3-level triage system has been commonly used in Turkey.…”

“…[20] It was also shown that the triage level application has changed according to the number of incoming patients; while 5-level ESI triage system applied in 78.3% of crowded emergency departments having more than 100.000 or more annual urgent patients, 3-level triage system has been applied in 60.2% of the emergency departments having less than 1.000 annual urgent patients. [20,21] As suggested in the statement published in 2009 by the Ministry of Health of Turkish Government, the 3-level triage system has been commonly used in Turkey. In 3-level triage system, patients are categorized as emergent (red), urgent (yellow) and non-urgent (green).…”