The document discusses triage and the Emergency Severity Index (ESI) system used in emergency rooms. It defines triage as the process of placing patients in the right place to receive the appropriate level of care. The ESI is a 5-level triage scale that assesses urgency and expected resource needs. It provides an algorithm to classify patients into levels 1 to 5 based on acuity, with level 1 being the most urgent and resources being estimated for each level. The objectives are to define triage and ESI, classify patients using ESI, and determine expected resource needs to match patients to the appropriate level of care.

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E M E R G E N C Y R O O M
P R E S E N T E D B Y :
M O H A N N A D A L G H A R A Y B E H
Triage
Emergency Severity Index

2. Out Line :
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 Definition of triage .
 The personal abilities that are essential to be
an effective triage nurse
 Daily triage in hospital setting .
 Triage process .
 What is ESI ?
 ESI ALGORITHIM
 Resources .

3. Objectives :
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At the end of this lecture , all audiences will be able to :
• Define the Triage and ESI .
• Classify the patients by using ESI on their level of
acuity .
• Expect how many resources needed for
patients to but them on there level .
• Differentiate between resources and
non-resources on your hospital .

4. Definition of triage
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 It is the process which places the right
patient in the right place at the right time to
receive the right level of care.
 Accurate triage allow the nurse to do
the greatest good for the greatest number of
afflicted .

5. The personal abilities that are essential to be an effective
triage nurse
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 Clinically experience .
 Good judgment and leadership .
 Calm and cool under stress.
 Knowledgeable of available resources .
 Creative problem solver .
 Availability .
 Experienced and knowledgeable

6. Daily Triage in Hospital Setting:
 Nurses perform daily triage on a routine
bases every day in the emergency
department .
The purpose :
 Is to identify those patient who have the
highest degree of compromise for the purpose of
providing rapid care to the sickest patient
first .

7. Triage Process
1- Gathering information at point of triage . “ AMPLE”
2- Perform initial assessment ( assessment sheet )
at point of triage . “Primary survey”
 The goal of triage process :
togather sufficient data for
determining acuity and identify
immediate needs .
 Triage process should be completed within 5
minutes.

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What is ESI?
 Emergency Severity Index
 A five level triage scale that uses prioritization based
on urgency (acuity) of condition but also considers
resources needed to get the patient thru to ED
disposition.
 Rapid, accurate triage is key to successful emergency
department operations.

9. What is ESI?
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 Undertriage leaves a patient at risk for
deteriorating while waiting. Overtriage uses
scarce resources limiting availability of an open
ED bed for another more critical patient.
Initial triage must be accurate.
 ESI is a tool for Emergency Department Triage.
 The Algorithm yields rapid, reproducible, and clinically
relevant stratification of patients into five groups-from
Level 1 (Most urgent) to Level 5 (least urgent).

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So, a 5 Level rating?
 5 levels have meaningful differences between
each level compared to previous 3 Level
systems.
 ESI levels can be used to describe acuity levels.
 ESI levels can be used to describe acuity of
patients.

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Emergency Severity Index
ESI
• Acuity assessment
- Airway, breathing, circulation
- Potential for life, organ or limb threat
- How soon the patient needs to be seen
• Expected resource assessment
- Number of resources, as estimated by the
triage nurse, that a patient is expected to
consume in order for a disposition decision.

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ESI ALGORITHIM

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• An experienced triage nurse is able to
recognize a patient in extremis with an
across the room brief assessment.
• Level 1 patients comprise 1-3% of all ED
patients.

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24. Decision Point B
is this a high risk situation?
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 The nurse utilizes experience to identify a patient
at High Risk.
 ESI level 2 patients are a high priority and
placement and treatment should begin within 10
minutes of arrival.

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Resource Examples
 CBC,BMP, PT/PTT=One Resource
 CBC, CXR=Two Resources
 CXR, ABD Series=One Resource
 CXR,CT Scan=Two Resources
 CBC,CT Scan, EKG=Three Resources

35. ESI Level 5
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 No resources .
 Examples :
 healthy 52 year oldv who ran out of his blood
pressure medicine yesterday .
 22 year old , involved in a car accident 2 days ago ,
wants to be checked . Nothing hurts .
 46 year old with a common cold .

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42. Summary
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Resources
• Emergency Severity Index (ESI) A Triage Tool for Emerge
ncy Department Care Version 4