Coleen Bejot,RN, BSN

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Coleen Bejot,RN, BSNDenise Arzoomanian,RN, BSN

• EDUC6584
• Spring 2004

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Emergency Severity Index

• Triage Module

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What is ESI?

• The Emergency Severity Index is a simple to use,
  five level triage instrument that categorizes
  emergency department patients by both acuity and
  expected resource needs.

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Why ESI?

• To facilitate the prioritization of patients
  based on the urgency of the patients condition.

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Benefits of ESI

• Rapid identification of patients that need
  immediate attention
• Quick sorting of patients in the setting of
  constrained resources
• Discrimination of patients who do not need to be
  seen in the main ED but could safely be seen in
  fast track

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Triage Categories
7
yes
A
Is the patient dying?
1
No
Can the patient wait?
No
B
yes
Algorithm
How many resources does this patient need? None
One Many
2
C
D
yes
5
4
Vital Signs Abnormal
No
3
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Decision Point A

• ESI Level I

• Is this patient dying?
• Is this patient unresponsive?
• Is this patient intubated, apneic or pulseless?

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Examples of Level I

• Cardiac Arrest
• Respiratory Arrest
• Critically injured trauma patient who presents
  unresponsive
• Overdose with respiratory rate of 6
• Severe respiratory distress with agonal or
  gasping-type respirations
• Anaphylactic reaction
• Baby with an obstructed airway
• Unresponsive with strong odor of ETOH
• Hypoglycemia with a change in mental status

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Decision Point B

• Is this a patient who can wait to be seen?
• If the answer is NO the patient is triaged as ESI
  level 2
• If the answer is YES the patient can wait, then
  the user moves to the next step in the algorithm.

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AskThree Questions

• Is this a high risk situation?
• Is the patient confused, lethargic, or
  disoriented?
• Is the patient in severe pain or distress?

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Decision Point C

• If the answers to the first two steps are no
  then the triage nurse moves to decision point C.
• How many different resources do you think this
  patient is going to consume in order for the
  physician to reach a disposition decision?
• Ask yourself, What is typically done for the
  patient who presents to the emergency department
  with this common complaint

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ESI Levels

• ESI level III gtgtgt2 or more resources
• ESI level IV gtgtgt one resource
• ESI level V gtgtgtgt No resources
• ESI resources are predicted by thinking about the
  common approaches to the most common presenting
  problems.

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Expected Resources Needed

• Provides additional data and allows a better,
  more accurate triage decision.
• Discrimminates at presentation low versus high
  resource requirements allowing for more effective
  streaming of patients at ED presentation
• The triage nurse only considers resources when
  the answers to decision points A and B are No

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Expected Resources Needed (cont)

• Resources are those that indicate a level of
  assessment or procedure beyond an exam or brief
  intervention by the ED staff.
• Those resources that require staff or resources
  outside the ED increase the patients ED length
  of stay

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ESI Resources
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Decision Point D

• Prior to assigning a patient to the ESI level 3
  category, the nurse needs to look at the
  patients vital signs.
• Are they outside the accepted parameters?
• If they are, then consider upgrading the triage
  level to ESI level 2.

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The Nurses say Thank You