Information Technology Reference
In-Depth Information
to make patient assessments in order to properly anticipate the resources needed for
each patient and recognize abnormal vital signs; thus, tools such as the ESI are “only
as good as the person using them” [39]. For example, a study conducted among 305
triage ratings comparing triage nurses' ratings to retrospective ratings assigned by
an expert panel of emergency department triage nurses revealed an agreement in
approximately half of the cases [47].
Of course the primary goal of triage is to decrease morbidity and mortality for
all ED patients. However, a gap in the knowledge exists regarding the real time
reasoning process of clinical decision making that occurs during ED triage [5, 17].
The ESI uses the following scale based on decision points to determine its cate-
gories [3, 16]:
•
ESI category 1-Emergent:
patient intubated, without pulse or respiration, or
unresponsive. i.e the patient requires immediate life-saving intervention so as to
prevent loss of life, limb, or eyesight,
•
ESI category 2-Urgent:
patient is in a high-risk situation, or confused, lethargic
or disoriented, or in severe pain, or danger zone vital signs.
•
ESI category 3-Acute:
patient is in need of many resources to be taken care
of. These may include, for example, Laboratory Tests, ECG, X-rays, CT-MRI-
ultrasound-angiography, IV fluids, specialty consultation, complex procedures
etc.
•
ESI category 4-Routine:
patient is in need of one resource.
•
ESI category 5-Non urgent:
patient is in need of no resources.
It is interesting to note that specific guidelines do not exist within the triage proce-
dure and a great deal is relied on the experience of the triaging nurse. For example
the Joint Commission on Accreditation of Healthcare Organizations does not specif-
ically state a standard for vital signs. The organization does assert that physiologic
parameters should be assessed as determined by patient condition but JCAHO does
not require vital signs to be done during triage. Vital signs are usually recorded if
the triage nurse determines they may be useful [16].
27.3.3
Triaging Elderly Patients
In a study of 929 Emergency Department visits of patients older than 65, it was
found that in general the ESI algorithm demonstrates validity. However, patients,
particularly elderly ones (but not only), frequently present to emergency depart-
ments (EDs) with non-specific complaints (NSCs) such as “not feeling well,” “feel-
ing weak,” “being tired,” feeling “dizzy,”or simply being unable to cope with usual
daily activities [49]. Studies have shown that up to 20% of older individuals pre-
senting to the ED have no specific complaints [50] while 50% of older individuals
without specific complaints suffered from an acute medical problem [33] and were
at a particularly high-risk group for adverse outcomes (e.g. functional decline, de-
pendence, and death) [24]. The difficulty arising from the uncertainty in the diag-
nostic process for these patients may lead to ineffective or suboptimal triage of these
patients [27].
