Free Essay

How to Use a 5-Level Triage System

In: Other Topics

Submitted By adena702
Words 1031
Pages 5
How to Use a 5-level Triage System
Western Governors University

Topic: The importance and application of a 5-level triage system.

INTRODUCTION
Attention Getter: I am currently a Charge Nurse in the busiest emergency room in Nevada. We see an average of 300 patients a day with wait time in the lobby upwards of 12-14 hours.
Purpose: The purpose of my presentation is to inform. I want my audience to understand why a 5-level triage system is best practice and I want my audience members to have a basic understanding of a 5-level triage system and to be able to begin training in an ER triage setting.

Audience: The ideal audience for my presentation are nurses that are newly graduated or new to the ER setting. My topic is specific for my intended audience and is beneficial for them. This presentation can be easily altered to address nurses that will be working in a pediatric ER.

Significance: The ability to correctly triage a patient in an ER is crucial to patient safety and patient care. In a busy ER patients generally have to wait to be taken out of the waiting area. A triage nurse needs to be able to sort through the patients and decide who the priorities are. The intended audience will become the nurses making these decisions.

Thesis Statement: Research shows that a 5-level triage system is best practice because ESI and CTAS provide dependability and reliability and because the implementation of a standardized ER triage process improves patient care.

I. First Main Point: A 5-level triage system is best practice because ESI and CTAS provide dependability and reliability.
A. Previous triage systems broke levels down to Emergent, Urgent, and Non-Urgent. These previous systems had less standardization then the 5-level ESI system.
B. Chart reviews revealed that there was rarely any correlation between triage acuity assignments and patient outcomes: patients triaged as Non-Urgent were admitted sometimes; patients triaged into a higher acuity category of Emergent or Urgent were often discharged. The triage acuity was often assigned with no clear clinical indication for the level, and the nursing documentation to support the assigned triage level was also lacking. Therefore, patient outcomes and resource utilization could not be anticipated on the basis of triage level. (Daniels, 2007, p. 59)
C. According to a study done of ER professionals in 2010 they were very satisfied with ESI. They indicated that ESI is more accurate than other triage algorithms and reduces the subjectivity of triage.(Singer, Infante, Oppenheimer, West, & Siegel, 2012, p. 120)
II. Second Main Point: Learning a 5-level ESI triage process to improve patient care.
A. ESI Levels 1-5
a. Level 1 patients are patients that are in cardiac/respiratory arrest or require any life-saving interventions immediately.
b. Level 2 patients are patients that are in a typically high risk situation. For instance – chest pain, altered mental status, psychiatric conditions requiring supervision, and severe pain.
c. Level 3-5 patients are decided based on resources. Level 5 uses no resources, Level 4 uses one resource, and Level 3 requires multiple resources.
d. The Triage Algorithm shows how to triage patients using chief complaint, vital signs, and resources needed. It also shows pediatric considerations for triage.

Resources Not Resources
• Labs (blood, urine).
• ECG, X-rays.
• CT-MRI-ultrasound-angiography. • History & physical (including pelvic).
• Point-of-care testing.
• IV fluids (hydration). • Saline or heplock.
• IV or IM or nebulized medications. • PO medications.
• Tetanus immunization.
• Prescription refills.
• Specialty consultation. • Phone call to PCP.
• Simple procedure =1 (lac repair, foley cath).
• Complex procedure =2 (conscious sedation). • Simple wound care (dressings, recheck).
• Crutches, splints, slings.
D. Danger Zone Vital Signs. Consider uptriage to ESI 2 if any vital sign criterion is exceeded.
Pediatric Fever Considerations:
1. 1 to 28 days of age: assign at least ESI 2 if temp >38.0 C (100.4F).
2. 1-3 months of age: consider assigning ESI 2 if temp >38.0 C (100.4F).
3. 3 months to 3 yrs of age: consider assigning ESI 3 if: temp >39.0 C (102.2 F), or incomplete immunizations, or no obvious source of fever.
(ESI Triage Research Team, 2014, Appendix B)

Summary: In summary, hospitals that have implemented a 5-level triage system have had better patient outcomes. Triage nurses throughout an emergency room can now consistently assign a triage level that is appropriate for patient care and outcome. When implementing a 5-level triage system multiple nurses will triage the same patient at the same level.
Questions:
1. Do I ever triage a patient based on times for an ER’s arrival to departure requirements?
No. Although many ERs are now tracking arrival to departure times you cannot triage a person based on the length of time for a resource. For instance, if you have a fast track area that sees level 4 patients and your CT department is behind in CTs you would not make your level 4 patient a level 3 to fall into the time requirements.
2. Why is there a significant difference between a 4-level and a 5-level triage system?
Education and training are probably the biggest factor. When the 5-level system was implemented there was training provided to staff members. This included an algorithm to follow. The 4-level system left the decision between levels to be made by each individual nurse.
3. Do you always have to completely follow the ESI algorithm?
No. Although this system works very well there are times that other factors have to be considered, such as, patient age, history, and medications

References
Daniels, J. H. (2007). Outcomes of Emergency Severity Index Five-Level Triage Implementation. Advanced Emergency Nursing Journal, 29(1), 59. Retrieved from www.ena.org
ESI Triage Research Team. (2014). Emergency Severity Index (ESI): A Triage Tool for Emergency Departments. Retrieved from http://www.ahrq.gov/professionals/systems/hospital/esi/esiappb.html
Singer, R. F., Infante, A. A., Oppenheimer, C. C., West, C. A., & Siegel, B. (2012, March). The use of and satisfaction with the emergency severity index. Journal of Emergency Nursing, 38(2), 120-126. Retrieved from www.jenonline.org

Similar Documents

Free Essay

University Health Services

...1. With the help of process flow diagrams, compare the pre-triage and the post-triage systems in terms of total system time and total waiting times. Is the new system an improvement over the old? 2. Look at the patient arrival rates and compare them to the available MD and NP capacity. An hour-by-hour or day-by-day analysis will show some interesting patterns. Based on what you have learned about waiting lines and utilization, comment on the current assignment fitness between supply and demand?   |  |  |  |Patients waiting |Patients waiting |  |  |  |  | |  |  |67% |33% |MD |NP |Availability |  |Patients per hour treated |  | |  |Arrival |MD |NP |Beg of HR |Serviced |End of HR |Beg of HR |Serviced |End of HR |MD |NP |MD |NP | |8am - 9am |18.2 |12.194 |6.006 | - | 6.19 | 6.01 | - | 3.66 | 2.35 |2.0 |2 |3.0927835 |1.8292683 | |9am - 10am |17.6 |11.792 |5.808 | 6.01 | 7.73 | 10.07 | 2.35 | 7.32 | 0.84 |2.5 |4 |  |  | |10am - 11am |16.8 |11.256 |5.544 | 10.07 | 14.85 | 6.48 | 0.84 | 7.32 | (0.93) |4.8 |4 |  |  | |11am - 12 noon |15.2 |10.184 |5.016 | 6.48 | 9.90 | 6.77 | (0.93) | 7.32 | (3.24) |3.2 |4 |  |  | |12 noon - 1pm |11.8 |7.906 |3.894 | 6.77 | 8.04 | 6.63 | (3...

Words: 1270 - Pages: 6

Premium Essay

Assess the View That Factors Within a School Are the Main Cause for Social Class Differences in Educational Achievement (20 Marks)

...of their behaviour or appearance. Becker found some evidence behind this after he did some research on high school teachers. He found they would label students according to how closely they fitted the image of the, “ideal pupil.” Pupils work conduct and appearance were the key factors in influencing their judgement. Cicourel and Kitsuse also found some evidence when studying counsellors. They found inconsistencies in the way in which students suitability for courses were assessed. The councellors said they judged students according to their ability. In practise however they judged them on the basis of social class or race. Middle class students were more likely to be placed on higher level courses and seen as suitable college material. Following on from this labelling theory, Rist did some research and found that teachers used a range of methods to place students in separate groups and this had implications in terms of access to knowledge and achievement. Each pupil was streamed into a different group. Streaming is when a teacher will allocate different ability groups to each pupil for whatever fits them best. Gillborn and Youdell said teachers use the notion of ability to decide who can potentially get five A*-C GCSEs. Working class and afro-caribbean children were put into lower sets and different levels of GCSE. This theory of streaming leads on to the action of self-fulfilling prophecy. This is a prediction...

Words: 1622 - Pages: 7

Premium Essay

Test Plan Template

...and help build the document from the template. All such red and blue text should be removed before submitting any formal documentation, including both draft and/or final, deliverables. **** Table of Contents 1 Introduction 3 1.1 Scope 3 1.1.1 In Scope 3 1.1.2 Out of Scope 3 1.2 Quality Objective 3 1.2.1 Primary Objective 3 1.2.2 Secondary Objective 4 1.3 Roles and Responsibilities 4 1.3.1 Developer 4 1.3.2 Adopter 4 1.3.3 Testing Process Management Team 4 1.4 Assumptions for Test Execution 5 1.5 Constraints for Test Execution 5 1.6 Definitions 6 2 Test Methodology 6 2.1 Purpose 6 2.1.1 Overview 6 2.1.2 Usability Testing 6 2.1.3 Unit Testing (Multiple) 7 2.1.4 Iteration/Regression Testing 7 2.1.5 Final release Testing 7 2.1.6 Testing completeness Criteria 8 2.2 Test Levels 8 2.2.1 Build Tests 8 2.2.1.1 Level 1 -...

Words: 5532 - Pages: 23

Premium Essay

Operations Management

...Student 30991 Malak Rostom Masters of Business Administration Module 5 Operations Management Title Hotel-Dieu De France Beirut-Lebanon Word Count: 3,477 CONTENTS I- Executive summary 3-4 II- Introduction 4 III- Company Profile 4-5 IV- Problem and Processes Description 5-8 1- Problem definition 5-6 2- Patients flow model at hdf 6-8 V- patient Flow and Capacity Theories 9-12 3- Process mapping 10 4- theory of constraints 10-11 5- lean tools 11-12 VI- HDF processes evaluation from the capacity theories perspective 12-16 VII- Proposed changes and their effects on customer service 16-18 VIII- Final Recommendations and conclusion 19-21 IX- REFERENCE ...

Words: 4360 - Pages: 18

Premium Essay

Requirement Engineering

...each interface in detail. Step 1: Mission and scope If you don’t know where you’re going, you’re not likely to end up there, said Forrest Gump. Is your mission clear? Write a short statement of what you want your project to achieve. Out of that will grow an understanding of the project’s scope. The scope will develop as you more clearly understand exactly what achieving the mission entails. A traditional context diagram is a good tool for describing scope in a simple outline. Unlike a use-case summary diagram, it indicates interfaces and the information or materials that must come in or out of them, rather than just roles (that is, UML actors). This becomes especially important when specifying physical systems 0740-7459/06/$20.00 © 2006 IEEE Step 2: Stakeholders Requirements come from people, not books. You can look in old system documents and read change requests, but you must still validate any candidate requirements you discover with people. Missing a group of stakeholders means your system could lack a whole chunk of functionality or other...

Words: 1692 - Pages: 7

Premium Essay

Zahra

...HOW TO USE CLASSICAL MANAGEMENT APPROACH IN UTILIZING ACCIDENT &EMERGENCY DEPA RMENT? BY ZAHRA AHMED EBRAHIM Master in Business Administration General Management Organization and Business Management Open Asia e University 2011 Introduction Background of the Study A number of approaches to the structure and management of organizations developed during the late 1800s and early 1900s .The early philosophies are traditionally labelled classical theory while the later approaches include systems theory and contingency theory. The classical approach to organization focuses efficiency through design. Eleanor and Phillip (2009) kept four elements to build classical theory: division and specialization of labour, chain of command, organizational structure, and span of control. The first element emphasised about dividing the work reduces the number of task that lead to proficiency and specialization. The second element is the chain of command which is meant the hierarchy of authority and responsibility within the organization. However, the collaboration between staff and there managers improve the efficiency and productivity of the unit. Moreover, the third element is organizational structure that describes the arrangement of the work group. The design of the Organization is intended to faster the organization survival and success. Finally, the span of control addresses the pragmatic concern of how many employees a manager can effectively supervise. The later......

Words: 3093 - Pages: 13

Free Essay

Do X-Rays Requested by Triage Nurses Decrease Waiting Times?

...Do X-rays Requested By Triage Nurses Decrease Waiting Times? Research in Health and Social Care Introduction: Since 1991 when the patient’s charter (Department of Health 1991) was introduced, Accident and Emergency (A&E) departments have been under pressure to see, treat and discharge patients within a certain time period. In 1991 75% of walking wounded who presented to the department had to be discharged within one hour. It was subsequently changed in 2004 when the government decided that 98% of all patients attending an A&E department should be in the department no longer than four hours (Department of Health 2004). And again in 2011 when the department of health introduced the clinical care indicators that relaxed the target to 95% seen, treated and discharged or admitted in 4 hours (Department of Health 2011). Triage nurses within the accident and emergency department are one of the first people to assess the patients who present with an injury or illness. The patient’s condition is assessed and their need for how quickly they require treatment is prioritised. Triage nurses are usually experienced A&E nurses who have many years A&E experience (Dolan et al 2007). Patients are then placed in queues to await assessment by a Doctor or Emergency Nurse Practitioner. Once seen they are then put in another queue to await x-ray if necessary before waiting again to see the doctor/ENP that will interpret their x-ray and decided on the best course of......

Words: 3738 - Pages: 15

Free Essay

Business Management

...Chapter 3: Process flow measures 3.3 Solutions to the Chapter Questions Discussion Question 3.1 The opposite of looking at average is looking at a specific flow unit’s flow time, and the inventory status and instantaneous flow rate at a specific point in time. Because flow times change from flow unit to flow unit, it is better to look at the average over all flow units during a period of time. Similar for inventory and throughput. [pic] Discussion Question 3.2 In practice, one often tracks inventory status periodically (each day, week, or month). Flow rate is typically also tracked periodically (even more frequently than inventory status because it directly relates to sales). It then is easy to calculate the average of those numbers to obtain average inventory and throughput during a period. In contrast, few companies track the flow time of each flow unit, which must be done to calculate the average flow time (over all flow units during a given period). [pic] Discussion Question 3.3 First, draw a process flow chart. Second, calculate all operational flows: throughput, inventory, and flow time for each activity. Third, calculate the financial flow associated with each activity. If the activity incurs a cost (or earns a revenue), the cost or revenue rate is simply the throughput times the unit cost or revenue. If the inventory incurs a holding cost, the inventory cost rate is simply the average inventory times the unit holding cost. Fourth,...

Words: 3357 - Pages: 14

Premium Essay

Mart-1

...if malignant melanoma has developed. Approximately 76,000 new cases of melanoma are diagnosed annually in the Unites States, which accounts for about 2% of the total skin cancer diagnosis in United States annually; however 75% of skin cancer related deaths are the result of MM which exhibits how devastating this form of cancer is. With early detection of melanoma being correlated highly to improved prognosis of patients, it is necessary to create a point of care device that can measure the presence of MART-1 antigen in peripheral blood as a screening technique during annual examinations and upon identification of suspicious skin lesions Protein melan-A  is a protein that in humans is encoded by the MLANA gene . A fragment of the protein, usually consisting of the nine amino acids 27 to 35, is bound byMHC class I complexes which present it to T cells of the immune system. These complexes can be found on the surface of melanoma cells. Decameric peptides (26-35) are being investigated as cancer vaccines. The names MART-1 and melan-A were coined by two groups of researchers who independently sequenced the gene for this antigen in 1994. Both names are currently in common use. Kawakami et al. at the National Cancer Institute coined the term MART-1, which stands for "melanoma antigen recognized by T-cells. ]Coulie et al. of Belgium...

Words: 4004 - Pages: 17

Premium Essay

Stuff

...day workings of the school, pupils become accustomed to accepting hierarchy and competition. Suggest three criticisms that other sociologists may make of the functionalist view of the education system? Functionalists see education as a process that instils the shared values of society as a while, but Marxists argue that education in capitalist society only transmits the ideology of a minority, the ruling class. The interactionist Dennis Wrong argues that functionalists have an ‘over-socialised view’ of people as mere puppets of society. Functionalists wrongly imply that pupils passively accept all they are taught and never reject the schools values. Unlike Davis and Moore, the New Right argue that the state education system fails to prepare young people adequately for work. This is because state control of education discourages efficiency, competition and choice. Outline some of the ways in which government educational policies may have affected social class differences in educational achievement? Marketisation brought in a change in selection policies, it brought in a funding formula that gives the school the same amount of funds for each pupil, also exam league tables that rank each school according to its exam performance and make no allowance for the level of ability of its pupils. But lastly a competition among schools to attract pupils to the school with the highest grades and make them want to do better so they get accepted into that school. ......

Words: 1003 - Pages: 5

Premium Essay

Decision of Uncertainty Paper

...Decision of Uncertainty Paper As a health care establishment, it is easy to become caught up in the day- to- day tasks at hand without addressing the needs or concerns of the patients. With the change in the economy and the reasons for the emergency room being utilized, it is important to take a moment to see how the flow of the delivery of services can be confined to smooth transitions. This paper will include appropriate probability concepts, rationale, statistical analysis, and a decision tailored to research studies specific to the thesis statement, question response types, and classification of our findings. Thesis Question "Does the emergency room get utilized more by a particular race and is there a reason for this occurrence?" Appropriate Probability Concepts and Your Application of Them to Find Resulting Data To Limit the Uncertainty of this Decision Probability theory is an important part of statistical theory that bridges descriptive and inferential statistics. It is the science of uncertainty, chance or likelihood (Cooper & Schindler, 2008). There are three kinds of probability; classical, empirical and subjective. In this instance, we will focus on a mixture of empirical probability which is based on past experiences and subjective probability which a probability is assigned to an event based upon whatever evidence is available. A closer look will be taken at the records of the patients treated by the emergency care......

Words: 984 - Pages: 4

Free Essay

The Turing Triage Test

...1 The Turing Triage Test Dr. Robert Sparrow Centre for Human Bioethics Faculty of Arts Monash University Victoria 3800 Australia. This paper appeared in print in: Ethics and Information Technology 6(4): 203-213. 2004. Please cite that version. 2 The Turing Triage Test Abstract If, as a number of writers have predicted, the computers of the future will possess intelligence and capacities that exceed our own then it seems as though they will be worthy of a moral respect at least equal to, and perhaps greater than, human beings. In this paper I propose a test to determine when we have reached that point. Inspired by Alan Turing’s (1950) original ‘Turing test’, which argued that we would be justified in conceding that machines could think if they could fill the role of a person in a conversation, I propose a test for when computers have achieved moral standing by asking when a computer might take the place of a human being in a moral dilemma, such as a ‘triage’ situation in which a choice must be made as to which of two human lives to save. We will know that machines have achieved moral standing comparable to a human when the replacement of one of these people with an artificial intelligence leaves the character of the dilemma intact. That is, when we might sometimes judge that it is reasonable to preserve the continuing existence of a machine over the life of a human being. This is the ‘Turing Triage Test’. I argue that if personhood is understood as a matter of......

Words: 9474 - Pages: 38

Premium Essay

Analytical Critique

...Quality Research Article Critique Factors Influencing Emergency Use of Nurse Practitioners: A Critique Problem and Purpose This is critique of a Qualitative Nursing article, the article is: Factors Influencing the Decision to Use Nurse Practitioners in the Emergency Department by Laurie A. McGee, MN, ARNP and Louise Kaplan, PhD, ARNP, published in Journal of Emergency Nursing, Volume 33, Number 5, October 2007. The problem that is stated in the article is there is a growing and serious problem facing the overcrowding of emergency rooms within the United States. There is a current epidemic of the population that relies on emergency room care as primary care. “The 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) reports an 18% increase in the number of visits to emergency departments from 1994 to 2004.” This causes long wait times and may cause emergency room doctors and nurses to be overworked allowing for a possibility for mistakes to handle the volume. “Overcrowding is defined as a situation in which demand for emergency services exceeds the ability of a department to provide quality care within acceptable time frames.” Overcrowding can delay care which is a patient safety issue and can lower patient satisfaction. “The Joint Commission on Accreditation of Healthcare Organizations' review of sentinel events has attributed patient deaths to delays in patient care. In hospital emergency departments, delay of treatment is the most common type of sentinel event.”...

Words: 1562 - Pages: 7

Free Essay

Master of Business Administration

...will be looking into the depth of these issues and try to highlight the key points that create such a situation. Our main objective is to find the gap between the perception and reality. We go about in our project first giving a brief introduction of the emergency department of health sector according to the secondary data that we collected. We also discussed the techniques, strategies and standard operational procedures i.e. SOP’s according to which emergencies should operate. Moreover we also discussed emergency ethics that are the first and foremost base to determine how the doctors are expected to behave with the patients and handle their problems. We have also conducted a primary research by observing and interviewing patients to fill out the survey questions. We have also included overviews of the journals taken from the health institutes in countries like USA, and Europe. It will help us get an insight on how these countries emergency departments are operating. The case study on dengue has been...

Words: 13489 - Pages: 54

Premium Essay

Clas

...Using material from Item A and elsewhere, assess the view that factors and processes within the school are the main cause of differences in the educational achievement of different social classes: There are many internal factors which affect the educational achievement of children within a school. Internal factor are factors inside the education system which explain class differences in achievement, such as poor teaching, type of school and how students are treated. Labelling plays an important role in different achievement between classes. To label someone is to attach a meaning or definition to someone, these could be positive or negative. As it says in Item A positive or negative labelling of pupils by teachers can have important effects on performance. Studies have shown that teachers often attach labels regardless of the pupil’s actual ability or attitude. Instead, they labelled the pupils on the basis of stereotyped assumptions about their class background, labelling working- class children negatively and middle- class children positively. A self- fulfilling prophecy is a prediction that comes true simply by the virtue of having being made. Interactionists argue that labelling can affect pupils’ achievement by creating a self- fulfilling prophecy. For example a teacher labels a pupil and on the basic of this label makes predictions about him. The teacher treats the pupil accordingly, acting as if the prediction they made is already true. The pupils then......

Words: 1264 - Pages: 6