Research Abstract
Implementing the Emergency Severity Index Triage System in the Homeland of Hippocrates

https://doi.org/10.1016/j.jen.2005.07.023Get rights and content

Section snippets

Purpose

Different triage systems have been developed and implemented in emergency departments, including the Australian National Triage Scale, the Canadian Triage and Acuity Scale, the Manchester Triage System, and the Emergency Severity Index (ESI). Implementation of a new triage system depends on strengths and weaknesses of available systems as well as organizational and cultural characteristics of an emergency department. The purpose of this study was to evaluate the implementation of the ESI system

Design

This retrospective, descriptive study examined patient records and hospital reports as well as nurses' interviews. Descriptive and inferential statistics were used for analyses.

Setting

The study was conducted at an emergency department of a large tertiary, teaching hospital in Thessaloniki, Greece. This emergency department is 1 of 8 departments that provide emergency and trauma care to 2 million citizens. At any given time, on an alternating schedule, only 2 of the 8 emergency departments operate 24 hours a day, which results in overcrowded waiting rooms.

Sample

During the study period from November 2, 2003, to September 30, 2004, 50,410 patients visited the emergency department, and their patient records were reviewed retrospectively. The sample was divided into 2 groups. The first group included all patients who visited the emergency department in the first 2 months of the study period (n = 5905), which was during the initial stage of ESI implementation (phase I). The second group included all patients who visited the emergency department during the

Methodology

Patients' records and hospital reports were screened for predictive validity outcomes associated with triage levels for both study phases so that comparisons could be made. In addition, data were gathered and comparisons were made related to admission rates, length of stay, mortality at triage, and patients leaving the emergency department after triage. Reliability of the ESI system was tested by measuring inter-rater agreement and test-retest agreement among 15 triage nurses who had at least 1

Results

The following results pertain to Phase I - Phase II and triage categories 1 through 5. Admission rates: (1) 100% - 100%, (2) 64.3% - 89.2%, (3) 22.8% - 33.6%, (4) 4.9% - 2.6%, and (5) 2.4% - 0.38%. Length of stay in minutes: (1) 1 - 1, (2) 4 - 4, (3) 24 - 17, (4) 72 - 62, and (5) 91 - 69. Mortality: 0.2% - 0.08%. Number of patients leaving the emergency department after triage: 4.47% - 3.18%. Inter-rater agreement: 88.5% - 84.5%. Test-retest agreement: 92% - 96%.

Conclusions

Utilization of a newly implemented ESI system was shown to be reliable and valid in this Greek emergency department. Outcomes improve with experience and through continuous follow-up during the implementation process.

References (0)

Cited by (0)

View full text