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

Abstract

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.

Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China

“…First, ophthalmic crises were concentrated on ocular disorders and had fewer considerations than general ED visits, which must take into account systemic manifestations. Second, most general EDs employed a four- or five-level classification system ( 27 – 29 ), which made triage more challenging for nurses than the three-level triage in our study.…”

“…First, ophthalmic crises were concentrated on ocular disorders and had fewer considerations than general ED visits, which must take into account systemic manifestations. Second, most general EDs employed a four-or five-level classification system ( [27][28][29], which made triage more challenging for nurses than the three-level triage in our study. Interestingly, although we confirmed that there was strong agreement between nurses and doctors, we discovered that nurses tended to give a "semi-emergency" grade to all patients.…”

Organisationsstruktur einer Notaufnahme: neue Regelungen gegen bekannte Probleme

“…Eine Arbeit aus Berlin konnte zeigen, dass diese Praxis nicht in die Realität übernommen werden sollte: 29,6% der ZNA-Patienten im Beobachtungszeitraum mit nicht dringlicher Triagierung laut MTS (Kategorie grün und blau) wurden dennoch stationär aufgenommen, von denen wiederum 9,4% auf die Intensivstation aufgenommen wurden und 0,8% noch im Krankenhaus verstarben 15 . In einer weiteren Publikation der LMU konnten die Autoren nachweisen, dass insbesondere bei internistischen und neurologischen Patienten die ESI-Triagierung den Ressourcenbedarf nicht zuverlässig vorhersagen kann und somit engmaschige Reevaluationen notwendig sind 16 . Dies zeigt auch die Limitationen der bestehenden Triagesysteme.…”

“…schen und neurologischen Patienten die ESI-Triagierung den Ressourcenbedarf nicht zuverlässig vorhersagen kann und somit engmaschige Reevaluationen notwendig sind[16]. Dies zeigt auch die Limitationen der bestehenden Triagesysteme.SchockraummanagementFür die Versorgung Schwerstkranker oder Schwerstverletzter ist ein gut funktionierendes Schockraummanagement von elementarer Bedeutung.…”