EMERGENCY

SEVERITY INDEX
(ESI)

TAUFIQ ABDULLAH

Adapted from the Emergency Severity Index (ESI) Refresher PowerPoint by William Alt, BSN, RN Dayle Ann McCary, MSN, RN, CEN
Emergency Severity Index (ESI)
 ESI is a five-level triage scale developed by ED physicians and nurses

 Provides a reliable, valid tool for determination of acuity

 Describes parameters for the rapid identification of those who need

immediate care

 Discriminates between patients that need to be seen emergently versus

urgently

 Improves patient flow based on rapid sorting with projected resource and
operational needs

Get the right patient to right resources in the right place

at the right time
Institute of Medicine (IOM)Aims
 Safety
 Avoiding injuries from care that is intended to help

 Effectiveness
 Providing services based on evidence and avoiding interventions not likely to benefit

 Patient-Centeredness
 Respectful and responsive to individual patient preferences, needs, values, in clinical
decision making

 Timeliness
 Reducing waits and sometimes harmful delays for those who receive care

 Efficiency
 Avoiding waste, in particular of equipment, supplies, ideas, energy

 Equitable Care
 Care that does not vary in quality due to personal characteristics (gender, ethnicity,
geographic location, or socio-economic status)
ESI Triage Algorithm
Decisions are based on 4 key questions:

A.Is this patient dying?

B.Is this a patient who shouldn't wait?

C.How many resources are needed?

D.What are the vital signs?

ESI TRIAGE ALGORITHM
 Decision Point Review
A. Determine if immediate life-saving intervention is required.

B. Is this a High risk situation? For example…

Is the patient confused or disoriented?
Is the patient in severe pain?

C. Consider the resources that the patient will require.

D. Review Vital Signs. Are they Danger Zone Vital Signs?: Consider triaging up to
ESI 2 if any vital signs are beyond patient’s normal parameters.
Adult:
HR >100
RR >20
Sa02 < 92% with clinically significant symptoms
RESOURCES NOT RESOURCES
 Labs (blood, urine) 
 History and physical (including pelvic)

 EKG, X-rays, 
 Point of Care Testing

 Saline or heplock
 CT,MRI, Ultrasound, 
 PO Meds
angiography

 Tetanus Immunization
 IV Fluids (Hydration)

 Prescription Refills
 IV, IM, nebulized medication

 Phone Call to PCP
 Specialty consultation

 Simple Wound Care
 Simple procedure = 1 (dressings, recheck)
(Laceration repair, Foley cath)
 Complex procedure =

 Crutches, splints, slings
(Conscious Sedation
 SUMMARY
Level 1 Resuscitation: Highest Priority
◦ Requires immediate life-saving interventions
◦ Is unresponsive
◦ May include suspected CVA with symptom onset < 3 hours
Level 2 Emergent : High risk situation
◦ Severe pain/distress, or
◦ Acute confusion, lethargy or disorientation
-----------------------------------------------------------------------------------------------------------------
Level 3 Urgent :
◦ Requires 2 or more resources as defined by Emergency Severity Index
Level 4 Less Urgent:
◦ Requires 1 resource as defined by Emergency Severity Index
Level 5 Non-Urgent: Lowest priority to be seen
◦ No resources required as defined by Emergency Severity Index

Levels 1 and 2 based on acuity

Levels 3, 4 and 5 based on anticipated resources
 REFERENCES
Gilboy, N., Tanabe. P, Travers DA, Rosenau, A.M., Eitel, D.R.
Emergency Severity Index, Version 4: Implementation Handbook.
AHRQ Publication No. 05-0046-2. Rockville, MD: Agency for
Healthcare Research and Quality. May 2005.

Alt, W. and McCary, D.A. Emergency Severity Index (ESI)

Refresher. 2013
Pediatric Triage PCTAS
There are three things that must be
assessed and documented on all
pediatric patients:
◦ Respiratory rate.
◦ Heart rate.
◦ Capillary refill.
 Pediatric CTAS
Poster Pocket Card
Pediatric Vital Signs
 Must include:
◦ Heart rate.
◦ Blood pressure.
◦ Respiratory rate.
◦ O2 saturation.
◦ Temperature.
◦ Capillary refill.
◦ Accurate weight!
Pediatric Vital Signs

Vitals Are Your Safety Net.

Less
Urgent and Non Urgent patients have
NORMAL vital signs.

Abnormal vital signs are at least an

URGENT.
General Approach to
POISONED Patient
 ABCs…IV, O2, monitor
◦ Decontaminate if organophosphates prior touching by
health care professionals
◦ Lily kit for cyanide poisoning.

 History
◦ Obtain all prescription and bottles in the household
(call pharmacy).
◦ Pill count.
◦ PM Hx.
◦ Search clothes for clues, medication alerts, pills etc.
◦ Contact family members.
◦ Track marks, consider body packing or stuffing.

 Vital signs, Rhythm strip.

General approach to poisoned
pt.

 What are the essential features of a

30-second toxicological exam?
◦ Vital signs- HR, RR, BP.
◦ Temperature- rectal
(resp rate can affect oral temperature).
◦ Skin- color, temperature, and sweating.
◦ Odors- provide clues
(their absence means nothing)
◦ Bowel sounds and bladder function.
◦ Mental status.
General approach to poisoned
pt
Tests

GI Decontamination
◦ Activated Charcoal
Antidotes
QUESTIONS????