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In This Issue

  • Triage
  • Case Study: Is Triage Really Necessary?
  • Best Practices: Rapid Triage
  • Innovations: Under-Triage

Triage
Triage is used in the emergency department (ED) to prioritize patients needing care. This system has long been entrenched in the emergency department system of care; however, the approaches to triage and their often accompanying issues can vary in EDs across the country.

This issue of the Urgent Matters E-Newsletter examines these approaches and questions this entrenchment. Ellen J. Weber, MD, FACEP, of the University of California, San Francisco (UCSF) argues in the “Case Study” below for the adoption of streamlining triage. Weber uses the United Kingdom's approach to triage as a model for inspiration. In this system, patients are not categorized by the Emergency Severity Index (ESI) but instead assessed only as high acuity or not. Conversely, the “Best Practices” article below highlights how the Children's National Medical Center in Washington, DC, was able to reduce arrival-to-triage times by implementing the ESI and a rapid triage process. In this issue's “Innovations,” Lisa Wolf's concept of "under-triage" is conceptualized in terms of the commonly used ESI, created to ease the triage process by stratifying patients on the basis of acuity and resource need but which ultimately leads to patients being mislabeling. Wolf establishes connections between this common issue of under-triage and delayed treatment in the ED.

 
Case Study: Is Triage Really Necessary?
Like their colleagues at most busy emergency departments across the United States, the ED staff at UCSF Medical Center in San Francisco use a structured triage process for all walk-in patients. A greeter nurse briefly screens patients on arrival, and those who have obvious life-threatening complaints are immediately placed in a treatment room.  All other patients are formally triaged before or after registration using the Emergency Severity Index (ESI). Then they are directed either to a treatment space or to the waiting room if no space is available. Read More >>
 
 
Best Practices: Rapid Triage
In 2006, the Children’s National Medical Center in Washington, DC, was able to reduce arrival-to-triage time from hours to less than 10 minutes. Children were waiting as long as two hours just to be triaged, prompting many families to leave before care could be administered. Staff knew something had to be done, and they hit upon a two-pronged approach: the ESI and rapid triage.Read More >>
 
Innovations: Under Triage
Emergency departments typically tackle throughput problems by reconfiguring physical spaces and implementing process changes to move patients more rapidly from triage to the area of the hospital where they can get the most appropriate care. These modifications help tremendously when a patient’s initial acuity assessment is accurate, but unfortunately they’re useless when a bad assessment sends a patient down the wrong clinical path.  Read More >>