RESEARCH
The Emergency Severity Index (version 3) 5-Level Triage System Scores Predict ED Resource Consumption

https://doi.org/10.1016/j.jen.2003.11.004Get rights and content

Abstract

Objectives

The Emergency Severity Index (ESI) version 3 is a valid and reliable 5-level triage instrument that is gaining in popularity. A unique component of the ESI algorithm is prediction of resource consumption. Our objective was to validate the ESI version 3 triage algorithm in a clinical setting for the following outcome measures: actual resource consumption and patient length of stay in the emergency department and hospital.

Methods

We conducted a retrospective, descriptive study of 403 ED patients who presented to a large academic medical center. The following dependant variables were abstracted from the ED record: number of ED resources used and emergency department and hospital length of stay. The relationship between ESI level and each of the dependent variables was determined.

Results

Mean resource use decreased monotonically as a function of ESI level 1 (5), 2 (3.89), 3 (3.3), 4 (1.2) and 5 (0.2). The ED average length of stay (minutes) per ESI level was as follows: 1 (195), 2 (255), 3 (304), 4 (193), and 5 (98). ESI triage level did not predict hospital length of stay.

Conclusions

The ESI algorithm accurately predicted ED resource intensity and gives administrators the opportunity to benchmark ED length of stay according to triage acuity level.

Section snippets

STUDY DESIGN/SETTING/SAMPLE

We performed a retrospective descriptive study of 403 ED patients who presented to our emergency department ED from May through October 2001. The study was reviewed and approved by our Institutional Review Board with exemption from patient consent and performed at a large academic urban medical center with approximately 70,000 ED visits annually. All patient visits during the study enrollment period were eligible for inclusion. In an attempt to sample all 5 acuity levels, we intentionally

Results

Figure 2 presents the case mix of the sample for each ESI triage level and demonstrates that a very small number of patients met ESI level 1 or 5 criteria. Of the 403 patients in this study, 204 (51%) were male. The mean age across all patients was 44.8 years (SD = 20.6), the median age was 46 years, and patients ranged between 3 months and 102 years of age. In general, our sample was primarily adult; only 14 patients were younger than 18 years. One hundred ninety-nine patients were admitted to

Discussion

Our data validate the ability of the ESI version 3 to describe and predict ED resource utilization characteristics according to triage level. These benefits are not realized with a 3-level system. Additionally, ESI will give individual hospitals the ability to benchmark with other emergency departments, both nationally and internationally, who use the ESI.

Limitations and future directions

Several limitations should be discussed. True randomization techniques were not used for patient selection; however, we believe our selection technique did not compromise the results. We used a retrospective design. To ensure the ability to evaluate low-acuity and high-acuity patients, we intentionally selected an equal number of admission and discharges; therefore, our case mix description is based on an equal number of admissions and discharges. Our data reflect the percentage of admissions

Conclusions

The ESI algorithm can be used to accurately predict ED resource consumption and can be helpful in optimizing resource management.

Acknowledgements

This article is dedicated to the memory of Richard Wuerz, MD. We are grateful for his vision and dedication to the development of a reliable and valid 5-level triage system. We also thank Debbie Travers and Nicki Gilboy for their continuous “ESI” expertise. Finally, we thank Alexis Bergan-Guzman for her assistance with the graphic design of our figures.

References (14)

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This article was a poster presentation at the scientific meeting of the Society of Academic Emergency Medicine, 2003, Boston, Mass.

This project was supported by an Excellence in Academic Medicine grant from the State of Illinois and Northwestern Memorial Hospital and an endowed fund donated by Abra Prentice Wilkin to emergency medicine. Dr Tanabe is currently supported as a Ruth L. Kirschstein National Research Service Award postdoctoral fellow at the Institute for Health Services Research and Policy Studies of Northwestern University's Feinberg School of Medicine under an institutional award from the Agency for Healthcare Research and Quality. None of the authors has any relationships with any companies that would compromise the integrity of the project.

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