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Emergency Severity Index (ESI)
Emergency Severity Index (ESI)
SEVERITY INDEX
(ESI)
Improves patient flow based on rapid sorting with projected resource and
operational needs
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:
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
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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