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Emergency Departments and Triage:

Is the current practice of triage sufficient in emergency departments?

Christine Chao

Northeastern University





















2014 ICEM Proposal: Customer Quality
Emergency Departments and Triage
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Emergency situations often arise from a combination of physical and
physiological stress, which can be sudden and even life threatening, leading a
patient to the emergency department. Emergency departments all over the world
employ triage to manage overcrowding with the goal of prioritizing cases in terms of
clinical urgency (Aacharya et al., 2011). However, a number of obstacles stand
between patients arriving at a hospital and receiving medical care they require.
Improvements can be made to the current system to improve the quality of patient
care. The aim of this paper is to provide a critical review of the current triage system
and efficiency of emergency departments.
The number one complaint of emergency departments across the country is
the waiting time. Of 123.8 millions visits to U.S. emergency departments, only 18%
were seen in the first 15 minutes (American College of Emergency Physicians,
2004). Volume of patients coming in at a certain time cannot be planned, putting
emergency department resources at the risk of being overwhelmed. According to a
study on national trends done, practice intensity is the main factor driving up
occupancy levels (Pitts et al., 2012). Overcrowding often occurs as a result wherein
patients waiting to be seen, undergoing assessments or treatments, or waiting to
leave exceeds the capacity of the emergency department and/or staff. This often
leads to reduced quality of care, endangerment of patient safety, decrease in staff
morale, and increased cost of care (Gilboy, 2012). Lack of efficiency accounts for
many delays and there is room for improvement. Studies can be further done
determining which tests are necessary when evaluating a patient and whether the
benefits outweigh the time taken to perform such assessments.
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In addition, treatment time of simple and complex patients are relatively
equal. There is no significant difference in patients needing immediate or emergent
care or whether the patient is waiting in a patient bed (Hing, 2012). This statistic
points to two major flaws: resources are not being distributed proficiently and
patient care is significantly compromised. A further look into how patient
information is being passed from department to department may help.
Currently in the United States, many hospitals have adopted the 5-level
Emergency Severity Index (ESI) system (Christ, 2010). Urgent patients are classified
as ESI-1 and 2 while non-urgent patients are designated an ESI-3, 4, or 5. The
current triage system solely sorts and prioritizes patients based on urgency. The
tendency to overtriage, in which patients are given a higher number than their case
warrants, can increase cost of care and worsen the outcome (Gilboy, 2012).
Considering a triage system in which complexity and urgency are assessed side-by-
side could be needed.

















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References

Aacharya, R., Denier, Y., & Gastmans, C. (2011, Oct 7) Emergency Department Triage:
An Analysis. BMC Emergency Medicine, 11(16), 1-13.

American College of Emergency Physicians. (2004). Efficiency in the Emergency
Department. American College of Emergency Physicians. Retrieved from
http://www.acep.org/content.aspx?id=29876

Christ, M., Grossman, F., Winter, D., Bingisser, R., & Platz, E. (2010, December 17).
Modern Triage in the Emergency Department. Dutsch Arztebl Intl, 107: 892-
898. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021905/.

Gilboy, N., Tanabe, P., Travers, D., & Rosenau, A. (2012, January 1). Emergency
Severity Index (ESI): A Triage Tool for Emergency Department. Agency for
Healthcare Research and Quality, 4. Retrieved from
http://www.ahrq.gov/professionals/systems/hospital/esi/esi1.html.

Hing, E. & Bhuiya, F. (2012 Aug). Wait Time for Treatment in Hospital Emergency
Departments: 2009. Centers for Disease Control and Prevention, 102: 1-8
Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db102.htm#patient.

Pitts, S., Pines, J., Handrigan, M., & Kellermann, A. (2012 Dec). National Trends in
Emergency Department Occupancy, 2001 to 2008: Effect of Inpatient
Admissions Versus Emergency Department Practice Intensity. Annals of
Emergency Medicine, 60(6): 679-686. Retrieved from
http://www.annemergmed.com/article/S0196-0644%2812%2900507-
0/abstract.