Emergency Severity Index and Triage Tips for New Emergency Nurses
Summary
TLDRThe video from Emergency Chaos provides essential tips for new ER nurses, focusing on the Emergency Severity Index (ESI) and triage processes. It explains how to prioritize patients based on the severity of their condition, from life-threatening (ESI level 1) to non-urgent (ESI level 5). The guide highlights the importance of accurate assessment, understanding resource needs, and utilizing protocols for effective patient management. It also emphasizes the value of experience, advocating for patients, and offering practical tips to ensure efficient care in the emergency department.
Takeaways
- đ Triage is the process of sorting patients based on their severity to prioritize those who need immediate care in situations where resources are limited.
- đ„ The Emergency Severity Index (ESI) is a 5-level algorithm used to categorize ER patients based on the urgency of their condition and the resources they may require.
- đŽ ESI Level 1 patients are in critical, life-threatening conditions (e.g., cardiac or respiratory arrest) and require immediate intervention.
- đ ESI Level 2 patients have potentially life-threatening conditions (e.g., chest pain or stroke symptoms) and should be seen within 10 minutes of arrival.
- đĄ ESI Level 3 patients have stable vital signs but need prompt evaluation and at least two resources for diagnosis and treatment (e.g., abdominal pain or fractures).
- đą ESI Level 4 patients are stable and only require one resource (e.g., minor burns or lacerations needing sutures) and can wait longer for care.
- đ” ESI Level 5 patients are non-urgent cases (e.g., medication refills or minor cold symptoms) that donât require immediate attention or any resources.
- đŹ Resources include diagnostic tests, imaging, IV medications, IV fluids, and consultations but exclude oral medications, history taking, and simple wound care.
- đ©ââïž Nurses performing triage should have a solid foundation in clinical skills, critical thinking, and experience (ideally over a year in ER) to make accurate decisions.
- đ Always follow the hospital's protocols for specific conditions like chest pain or pediatric fever and clearly communicate expected wait times to lower patient anxiety.
Q & A
What is the purpose of triage in an emergency setting?
-Triage is the process of sorting patients based on the severity of their condition to prioritize those who need urgent care. It helps allocate limited resources effectively, ensuring that the most critical patients are treated first.
What are the five levels of the Emergency Severity Index (ESI)?
-The five levels of the ESI are: ESI Level 1 (immediate, life-threatening conditions), ESI Level 2 (emergent, potentially life-threatening conditions), ESI Level 3 (urgent, stable but requiring prompt assessment), ESI Level 4 (less urgent, stable patients who can wait), and ESI Level 5 (non-urgent, patients with minor conditions).
What kinds of patients are classified as ESI Level 1?
-ESI Level 1 is assigned to patients with life-threatening conditions that require immediate intervention, such as cardiac or respiratory arrest, severe trauma, active hemorrhage, or acute myocardial infarction.
What distinguishes an ESI Level 2 patient from an ESI Level 1 patient?
-While both levels involve critical patients, ESI Level 2 patients are unstable and at risk of deteriorating without prompt treatment, but they are not in immediate life-threatening danger like ESI Level 1 patients. Level 2 patients should be seen within 10 minutes.
What are examples of patients who would be assigned an ESI Level 3?
-ESI Level 3 patients are stable but require two or more resources to diagnose and treat their condition. Examples include patients with abdominal pain, exacerbations of asthma or COPD without changes in vital signs, or possible fractures.
What resources are considered when determining an ESI level?
-Resources include diagnostic tests like blood work, imaging studies, IV medications, consultations, and procedures such as laceration repairs or chest tube placement. Simple wound dressings and oral medications do not count as resources.
What is a key question to ask when determining if a patient should be classified as ESI Level 1?
-The key question is: 'Is this patient dying right now?' If the answer is yes, the patient is classified as ESI Level 1 because they need immediate life-saving interventions.
How does a nurse differentiate between an ESI Level 2 and Level 3 patient?
-A nurse should ask whether they would feel comfortable sending the patient back to the lobby. If the patient has time-sensitive issues or unstable vital signs that prevent them from waiting, they are likely an ESI Level 2. Otherwise, they are an ESI Level 3.
Why is it important for nurses to have experience when working in triage?
-Triage requires nurses to make critical decisions based on clinical skills, patient assessments, and critical thinking. Experience helps nurses recognize patients at high risk for deterioration and confidently advocate for timely care.
What is the recommended protocol for pediatric patients with a fever under 28 days old?
-Newborns under 28 days old with a fever are automatically classified as ESI Level 2 because of their high risk for serious conditions. Accurate weight measurement is critical for proper medication dosing.
Outlines
đ©ș Understanding Triage and the Emergency Severity Index (ESI)
The introduction explains triage as the process of sorting patients based on their illness severity to prioritize critical cases. It also introduces the Emergency Severity Index (ESI), a five-level system used in emergency rooms to determine patient priority based on condition severity and resource needs. ESI level 1 represents the most critical patients needing immediate intervention, such as cardiac arrest or severe trauma. The importance of using resources efficiently in the emergency room is emphasized, as well as the goal of addressing the most life-threatening conditions first.
â±ïž ESI Levels 2-5: Differentiating Patient Priorities
This section describes ESI levels 2-5, which cover less severe but still urgent cases. ESI level 2 patients have potentially life-threatening conditions like chest pain or asthma attacks and must be seen within 10 minutes. ESI level 3 patients are stable but need prompt attention, such as those with abdominal pain or fractures. ESI level 4 patients are stable and require only one resource, like laceration repair or a UTI. ESI level 5 patients have non-urgent conditions, such as cold symptoms or medication refills, and can wait longer for care.
đ What Counts as a Resource in Triage?
Resources in triage include diagnostic tests (like blood work, x-rays, or CT scans) and treatments (like IV fluids or medications). Some procedures, such as laceration repair or chest tube placement, also count as resources. However, oral medications, point-of-care glucose testing, simple wound dressings, and history assessments do not count as resources. The importance of determining resource needs helps classify patients within ESI levels 3-5 based on the number of resources they will require for diagnosis and treatment.
đïž Making ESI Decisions and Nursing Tips for Triage
Nurses are guided on how to assign an appropriate ESI score. If a patient is dying or requires life-saving interventions (such as intubation), they are classified as ESI 1. Patients who are unstable but not dying are classified as ESI 2. For ESI 3 patients, nurses should assess whether they would feel comfortable allowing them to return to the waiting area. Nurses should also rely on clinical experience to advocate for their patients and ensure they get the necessary resources or bed assignment. The importance of efficient vitals checks and weight measurements for pediatric patients is also highlighted.
đ€ Trusting Your Gut in Triage and Communicating Wait Times
This section emphasizes trusting gut instincts when something feels off with a patient and seeking a second opinion when needed. Experience in triage is crucial for recognizing deteriorating conditions. Nurses should prepare patients with ESI levels 4 and 5 for long wait times, helping manage expectations and reduce frustration. The SAMPLE mnemonic (Signs and symptoms, Allergies, Medications, Past medical history, Last meal, and Event of the situation) is introduced as a helpful tool for asking patients relevant questions.
đ Knowing Protocols and Learning Resources for ER Nurses
The final paragraph encourages nurses to be familiar with their hospitalâs protocols for handling chest pain, pediatric fevers, fractures, strokes, and traumas. It mentions nurse-initiated orders for certain conditions, such as ordering tests for UTI symptoms or medications for fevers. Nurses are encouraged to continue learning and mastering emergency nursing basics through available books and resources. The script closes with a reminder that teamwork and a proactive approach are essential in emergency nursing.
Mindmap
Keywords
đĄTriage
đĄEmergency Severity Index (ESI)
đĄESI Level 1 (Immediate)
đĄESI Level 2 (Emergent)
đĄESI Level 3 (Urgent)
đĄResources
đĄCritical Thinking
đĄPediatric Patients
đĄESI Level 4 (Less Urgent)
đĄESI Level 5 (Non-Urgent)
Highlights
Introduction to Emergency Severity Index (ESI) and its importance for ER nurses.
Triage is the process of sorting patients based on how critical their condition is, prioritizing those who need immediate intervention.
ESI is a five-level triage algorithm, with level one being the most acute and level five the least urgent.
Level 1: Immediate, life-threatening conditions that require immediate intervention, such as cardiac or respiratory arrest, severe trauma, and acute myocardial infarction.
Level 2: Emergent cases requiring prompt attention, within 10 minutes, including chest pain with suspected ACS, moderate trauma, and stroke-like symptoms.
Level 3: Urgent cases that require evaluation within 30 minutes, including abdominal pain, syncope, or exacerbation of chronic conditions like asthma or COPD.
Level 4: Less urgent cases that can wait over an hour, including lacerations requiring sutures, sprains, and mild pain.
Level 5: Nonurgent cases that can wait for an extended period and do not require immediate attention, such as cold symptoms or medication refills.
Resources are defined as diagnostic tests and treatments, including lab work, imaging, IV medications, and procedures like laceration repairs or chest tube placement.
Oral medications, medication refills, and simple wound dressings are not counted as resources in the ESI system.
Questions to determine the correct ESI level: Is the patient dying? Are they unstable? Are they experiencing time-sensitive issues?
Level 1 patients require life-saving interventions like intubation, defibrillation, or needle decompression.
Nursing tips: Nurses should have at least one year of experience before handling triage due to the critical nature of patient prioritization.
Experience in triage helps nurses recognize high-risk patients and advocate for their care when resources are limited.
Use the SAMPLE mnemonic (Signs and symptoms, Allergies, Medications, Past medical history, Last meal, Event of the situation) to guide patient assessments.
Transcripts
welcome to emergency chaos where we
provide tips and tricks to make you a
better earners today we are going over
the emergency severity index and
providing triage tips for new ER nurses
thank you for your time so what is
triage it's the process of sorting
patients based on how ill they are with
the goal of prioritizing patients who
are more critical so that these patients
receive interventions first as you are
aware Staffing and resources are often
Limited in the ER triage helps us use
our limited resources more effectively
so triage occurs in the prehospital
setting and in the ER in the prehospital
setting EMS decides where and how to
transport patients base on their needs
in the ER trial can occur in the
designated triage area where patients
are seen after they walk into the ER or
in each individual room after they're
brought in by
ambulance so the sever the emergency
severity index is is a five level trial
algorithm algorithm ranging from again 1
to five with level one being the most
acute most ill patient so again it's a
five level Tri algorithm used to
prioritize patients in the emergency
department based on the Acuity of their
condition and the anticipated resources
needed again this anticipated resources
needed is very important we'll cover
what the resources are shortly so for an
ESI level one it's known as immediate
it is assigned to patients with
life-threatening conditions requiring
immediate interventions these patients
should be seen immediately and will need
many many resources examples of ESI
level ones can include cardiac and
respiratory arrest severe trauma severe
burns active severe Hemorrhage and acute
myocardial in inection the key is that
these patients need to be seen
immediately and be placed at a higher
priority than all other patients the ER
now an ESI level two is known as
emergent it is assigned to patients with
potentially life-threatening conditions
these patients are unstable and may
deteriorate without prompt medical
attention these patients should be seen
by a provider within 10 minutes examples
can include chest pain with suspected
ACS an asthma exacerbation moderate
trauma or even stroke like symptoms the
key is that these patients will have
unstable Vital Signs and or have a time
sensitive issue that
need prioritization above other patients
to prevent further deterioration again
these patients must must be seen within
10 minutes of arrival and will also use
again many resources and we'll cover
what the resources are in a little bit
now for an ESI level three it's known as
they're known as urgent patients it's
assigned to patients with stable Vital
Signs who do not require prompt who do
I'm sorry who do require prompt
assessment and interventions but their
condition is not lifethreatening at this
moment again these patients should be
seen somewhere within 30 minutes
examples can include abdominal pain
Syncopy or near Syncopy exacerbation of
a chronic issue like asthma or COPD
without changes in their Vital Signs
possible fractures skin infection
likeitis again these patients with an
ASI ESI level of three they they're
stable but they do require two or more
resources to diagnose and treat their
condition these patients should be seen
within 30 minutes again now for an ESI
level four they're known as less urgent
it's assigned to very stable patients
who can wait for an hour or longer these
patients do not have lifethreatening
conditions examples can include
lacerations requiring sutures sprains or
strains UTI minor burns and mild pain
these patients will only require one
resource and now for level five these
are known as nonurgent patients it it is
assigned to patients who do not require
immediate attention have no
life-threatening conditions and may wait
for an extended period of time examples
can include cold symptoms work noes
medication refills and even suture
removal these patients do not require
any resources and are able to wait for
an extended period of time so now what
does count as a resource resources
refers to diagnostic tests and
treatments again resources refers to
diagnostic tests and treatment included
can can be laboratory studies such as
blood work and urine Imaging studies
such as x-ray CTE ultrasound or MRI
medication such as IV meds IM meds and
subcutaneous medications here it's
important to know that oral medications
typically do not count as a resource
other resources include IV fluids such
as normal sailing or lactator ringers
and even consultation such as Cardiology
or or Ortho procedures also count such
as a laceration repair or an incision in
drainage or more complex procedures like
chest to placement Central lines align
and even
reductions now what is not count as a
resource typically oral medications do
not count as a research medication
refills point of care glucose testing
simple wound dressings assessments like
a history and physical and suture
removal do not count as a resource so
how do you go about selecting the
appropriate ESI score for a patient some
of the questions that you can ask
yourself is after you've done your
assessment you got a history you got a
set of vital signs you ask yourself is
this patient dying right if the answer
is yes they're an ESI of one for example
is this patient not breathing are they
severely hypoxic do they have a pulse
are they hypotensive but it's also
accompanied with signs of poor tissue
profusion like decreas mentation their
pale diaphoretic and so forth those
would be an ESI of one also if they need
life-saving intervention such as like
intubation defibrillation cardiov
version needle decompression or even PCI
if so these are going to be esis of one
because they need to be prioritized
above all other patients right because
they're dying now if they're not dying
are they unstable to the point where
they should not wait in the lobby or do
they have a time sensitive issue if the
answer is yes then they should be an ESI
of two for example are they experiencing
sense of a stroke is it a newborn with a
fever or an immuno compromised cancer
patient with infection symptoms are they
suicidal is it a shorter breath asmatic
patient that is hynic and sating
91% or another example can be a patient
endorsing uh vomiting blood who is also
teic cardic and hypotensive in the '90s
but they're still oriented they're still
maintaining what helps me differentiate
and determine the difference between ESI
level one and and two is asking whether
they're dying right now if they're not
dying then they're in ESI 2 because
they're still unstable now to
differentiate between an ESI 2 and an
ESI 3 what helps me figure this out is
if I ask myself would I be comfortable
with this patient going back to the
lobby and and or should they get my last
beted in the ER if I don't feel
comfortable with them going back to the
lobby because of a Vital sign or just
something is time sensitive and they
should I think they should take the last
bed they're most likely an ESI level too
now when it comes to the esis level
three four and five this is where we
need to focus on the resources
an ESI level of three patient will
require two or more resources as they
have a complaint that will require an
in-depth evaluation but they're deemed
stable and they're safe to wait for a
bit an ESI level four will only require
one resource and in ESI level five will
require no resources right so remember
these are what count as resources lab
studies Imaging studies most medications
IV fluids consultations and procedures
so you got to be mindful of these when
you're looking at the E size levels
three four and five now let's go into
specific nursing tips when it comes to
triage you have to advocate for yourself
you should not be in the triage area if
you do not have at least one year of
experience ideally too although we have
the ESI and protocols in place a huge
part of keeping patient safe in triage
comes from experience you you should
have a solid foundation in clinical
skills critical thinking and patient
assessments as these are essential for
making accurate decisions experience
helps you recognize when patients are at
high risk for deteriorating with
experience also comes confidence often
with high senses in the ER there aren't
many open bets and if your patient needs
a bed you need to confidently get your
point across to the charge to nurse as
to why this patient you're calling for
needs a bed right another exam another
tip is always obtain an accurate weight
for Pediatric patients medications uh
for peas are weight based so you need to
have an accurate weight um newborns with
the fever are automatically in isi of
two so anybody any any kid under 28
years under 20 uh 28 days old they need
to be and they have a favor they need to
be in ESI of too next uh connect
everything for the vitals like the blood
pressure the P socks everything you need
while you're speaking to the patient so
you can be more efficient so you don't
do one and then the other do both at the
same time and you need to always check a
point of care glucose for diabetics
other tips include that if you have a
gut feeling that something is off or
just the patient does not look right to
you get a second opinion a buddy nurse
the charge or even the provider you can
never be too safe and with time you will
get better and you will have a better
grasp for things but again if something
is off trust it but this is why
experience to be out in triage is a must
with esi's levels of four and five I let
patients know that the weight times are
going to be long and that we are doing
our best but they do need to anticipate
being in the ER for several hours this
helps a little with preventing patients
from getting too irritable you let them
know early on that the weight is going
to be long don't forget the pneumonic
sample to help you to help guide your
questions it stands for signs and
symptoms allergies medications past
medical history last meal and event of
the situation again know your
organization's protocols for chest pain
for Pediatric fevers for possible
fractures for strokes traumas and nurse
initiated orders such as ordering and
your analysis for UTI symptoms for
example your chest pain protocol your
Hospital May indicate that you order an
EKG a chest x-ray a troponin a CBC and a
chemistry and that's part of the
protocol when a patient comes to triage
the Pediatric protocol may say uh that
you get the accurate that you get the
accurate weight and that you medicate
this patient based on their weight for
their fever right keep it in mind things
making sure that the that the parents
didn't already give that medication
before arrival so make sure you know
your organization's
protocol and here if you would like to
continue learning and master the basics
of emergency nursing check out our books
on Amazon with the view inside option
you can take a look at the table of
contents to see what is included in the
book links are
below as always Teamwork Makes the Dream
workor and here at emergency chaos we
are proactive not reactive
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