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Emergency Severity Index (ESI): Is it broken?

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As published by DOTmed, November 20 2020.

 

Triage is a critical step in the care of a patient presenting to the emergency department for treatment. The emergency severity index (ESI) has been adopted in most US hospitals as a tool to yield quick, consistent clinical prioritizations of patients into five category groups. Recently, its effectiveness and reliability has been criticized, and new technology, such as artificial intelligence (AI) and machine learning (ML), has been proposed as an aide to the triage process. Experiences in hospitals across the US, however, have shown that ESI has not been implemented, validated and audited correctly, leading to a lack of competency and effective utilization. This leads to the question: is the ESI system itself flawed? This answer simply is no, but there are many opportunities to consider to ensure hospitals have a valid and reliable triage process in place.

Accurately assigning an ESI level upon patient arrival is paramount to the appropriate movement of the patient. Inappropriate ESI assignment, or delay of determining the ESI level, can result in poor patient outcomes, inefficient care delivery and diminished patient experience.”

Brian Armstrong and Renee Cecil

Philips

What is the ESI's purpose?

 

Since the ESI was developed in the late 1990s, the tool has been revised four times, with input from both physicians and nursing professionals. It is now utilized by more than 80% of emergency departments across the US, and has also been adopted by many facilities internationally.  A simple, single-page algorithm is used as a rapid guide to assist the nurse in assigning the appropriate ESI score that also enhances inter-rater reliability. The tool is structured in a way that focuses first on patient acuity and then assesses resource utilization as a proxy for acuity. 

 

Read the full article by DOTmed at https://www.dotmed.com/news/story/53049?s=newslog

About the authors

Chris Comeau

Brian Armstrong, MBA, BSN, NRP, FP-C, CCEMTP

Senior Consultant

Brian brings decades of clinical and leadership experience in prehospital, emergency department, inpatient, and disaster response situations. He is an innovative leader that thrives on helping teams achieve their best and improve processes through empowerment of stakeholders and change through evidence-based practice. He has provided support for six hurricanes, been a Navy Corpsman, a paramedic, a firefighter, and in the U.S. Army as an infantry scout, with combat service in Iraq, and more.
Chris Comeau

Renee Cecil, DNP, RN, CEN, TCRN, SANE, NREMT

Senior Consultant

Renee brings vast clinical and leadership experience, working in community hospitals, academic trauma centers, critical care, helicopter EMS services, and at a large healthcare system. She focuses on staff recognition and engagement, decreasing turnover, implementing team nursing, and improving collaboration between EMS and the ED team. She has helped implement process changes that have positively impacted patient and staff satisfaction, reduced wait times, and improved throughput.

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