North Carolina — Targeted Issue

Description

This handbook covers all details of the Emergency Severity Index, a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from least to most urgent based on acuity and, unique to ESI, resource needs. This edition introduces a new section (Chapter 6), developed in response to numerous requests for more detailed information on using the ESI algorithm with pediatric populations. The section recognizes that the needs of children in the emergency room differ from the needs of adults, including: Different physiological and psychological responses to stressors. More susceptibility to a range of conditions, such as viruses, dehydration, or radiation sickness. Limited ability to communicate with care providers; thus harder to quickly and accurately assess. In keeping with our mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, one of AHRQ's areas of emphasis is improved training for the health care workforce. This handbook will provide invaluable assistance to ED nurses, physicians, and administrators in the implementation of a comprehensive ESI educational program. In turn, a well-implemented ESI program will help hospital emergency departments rapidly identify patients in need of immediate attention, and better identify patients who could safely and more efficiently be seen in a fast-track or urgent-care area rather than in the main ED.

Author(s)/Presenter(s)

Travers, D., Waller A., Katznelson J., & Agans R

Abstract/Description

Objectives: The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites.

Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay.

Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi-square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67).

Conclusions: Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric-specific ESI educational materials to strengthen reliability and validity for pediatric triage.

Author(s)/Presenter(s)

Katznelson J, Hohenhaus S, Travers D, Agans R, Trocinski D, Waller A

Abstract/Description

No abstract available

Author(s)/Presenter(s)

Rosenau A, for the Pediatric ESI Research Consortium (A Waller, D Trocinski, D Travers, V Rupp, A Rosenau, N Mecham, J Katznelson, S Hohenhaus, T Eubanks, D Eitel, R Agans)

Abstract/Description

No abstract available

Author(s)/Presenter(s)

Travers D, Agans R, Eitel D, Mecham N, Rosenau A, Tanabe P, Trocinski D, Waller A

Abstract/Description

No abstract available