Emergency Severity Index

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The Emergency Severity Index is a 5-level triage algorithm that was developed by emergency physicians and nurses at Harvard Medical School , Boston, USA, in the late 1990s. In addition to other 5-level triage instruments such as the Manchester Triage System , the Australasian Triage Scale and the Canadian Triage and Acuity Scale , the Emergency Severity Index is a system that has been validated in the scientific literature. The aim of the “Emergency Severity Index” is to identify the patients who need to be seen and treated immediately by an emergency doctor. In addition, the patients who can receive delayed care without harm are recognized.

Triage in the emergency room

The term triage is derived from the French verb "trier" (German: "sort"). This is a term from military medicine and is used in Germany in disaster medicine and clinical emergency medicine .

Due to the problematic situation associated with the term triage of excluding patients with treatment that is too resource-intensive, the term initial assessment is now predominantly used in German emergency rooms (regardless of the system used); few emergency rooms use the term triage. The term “ sighting ”, which comes from German military medicine, is used exclusively in the preclinical setting. In contrast to triage, the first assessment (international: primary assessment ) defines the sorting principle with priority given to the individual medical aspect. This means that no patient is excluded from the treatment, only an assessment takes place according to the urgency of the treatment.

The goal of triage is that (international uniform definition) "The R portant patient to R ichtigen time on R is ichtigen place (treatment room)."

Principle of the "Emergency Severity Index"

In contrast to other triage systems, the Emergency Severity Index uses a two-stage approach to defining the group assignment for newly arriving emergency patients. First of all, patients with a high degree of urgency for treatment are identified; for the others, a group assignment (not the treatment sequence!) Is then determined based on the likely resource requirements. In appropriately large emergency rooms with different treatment areas, they are then assigned to the necessary treatment location.

The first decision step (decision point A) checks whether the patient is unstable ("Immediately life-saving intervention required"). These patients are assigned to category 1, and an immediate start of treatment is defined for them.

In the second decision step (decision point B) the question is decided whether this patient can wait. For this purpose, it is checked whether the situation is high-risk, whether the patient is acutely confused, lethargic or disoriented, or whether the patient is in severe pain or feels very unwell. This assessment requires that the nurse has experience in the assessment; the information collected includes subjective and objective information. These patients are assigned to category 2, the time limit is indirectly defined by the statement that this group includes all patients who are at risk of vital danger if they are not presented to a doctor within 10 minutes.

For patients who do not fall under the two categories above, the third decision step (decision point C) checks how many resources the patient will use during his treatment in the emergency room. X-ray examinations, sonography, CT, blood tests in the laboratory, application of a plaster cast, complex wound care, etc. are defined as resources. No resources are, for example, the creation of a prefabricated (splint) bandage, blood tests in the emergency room (any form of point-of-care diagnostics), small wound treatments, etc.

A patient who does not need a resource is assigned to category 5, whoever needs 1 resource is assigned to category 4, whoever needs 2 or more resources is assigned to category 3. Only for patients in category 3, the patient's vital signs are checked and rated according to age-appropriate limits. The nurse then checks whether, based on the results, they classify the patient higher (in category 2), whereby exceeding the limit values ​​does not trigger any obligation to higher grouping.

The result of the categorization using the Emergency Severity Index , like other triage instruments, is used to identify critically ill patients and to direct them to the necessary treatment. First results show that z. For example, critically ill patients with community-acquired pneumonia are better recognized and therefore have a lower hospital mortality.

Critical appraisal

In large American emergency rooms with labor highly organized activities, the system allows a quick assignment to specific treatment areas such as the emergency room , a chest pain unit or a Fast Track Unit. For these emergency rooms, the medical and nursing professional associations have set a maximum waiting time of 15 minutes before contacting the doctor - a requirement which, however, is often not adhered to. In German emergency rooms with a different division of labor, there is a risk that patients in categories 3 to 5 have an unrecognized high level of urgency and could be harmed by waiting too long.

On closer inspection, the Emergency Severity Index must be viewed as a combination of a three-level urgency system (0 min, 10 min, no time limit) with a three-level effort assessment system. Clinical studies have shown that the instrument supports these requirements in a valid and reliable way, even with special patient groups (older patients and children). Some papers published in international specialist journals show that this instrument, which has been translated into German, is safely used in emergency rooms in Switzerland. A transfer to German emergency rooms is thus possible under certain conditions (enough doctors to ensure contact with the doctor within 15 minutes).

literature

  • CM Fernandes, P. Tanabe, N. Gilboy et al .: Five-level triage: a report from the ACEP / ENA Five-level Triage Task Force. In: J Emerg Nurs. 31, 2005, pp. 39-50; quiz 118.
  • FF Grossmann, K. Delport, DI Keller: Emergency Severity Index: German translation of a valid triage instrument. In: Emergency and Rescue Medicine. 12, 2009, pp. 290-292.
  • RC Wuerz, D. Travers, N. Gilboy, DR Eitel, A. Rosenau, R. Yazhari: Implementation and refinement of the emergency severity index. In: Acad Emerg Med. 8, 2001, pp. 170-176.
  • R. Wuerz: Emergency severity index triage category is associated with six-month survival. In: ESI Triage Study Group. Acad Emerg Med. 8, 2001, pp. 61-64.

Individual evidence

  1. ↑ http://www.health.gov.au : Emergency Triage Education Kit. (on-line)
  2. ↑ http://www.caep.ca : Canadian Triage and Acuity Scale (CTAS). (on-line)

Web links