Emergency Severity Index

Arranged by: MLTominez

Purpose
• Prioritize in coming patient in the Emergency
Department
• Identify those who cannot wait to be seen
• Brief focused assessment
• How long can patient safely wait for a medical
screening
• In 2008 there were 123.8 million visits of patients in the ED’s (USA)
• CDC data – only 18% of patients were seen within 15 min, leaving
majority of the patients in the waiting room
• Worsening crisis
• Worldwide problem
• Leaves the patient for worsening conditions
 BRIEF HISTORY
• Develop by two ED Physicians (Richard Wuerz and David
Eitel)
• Who should be seen first?
• How long can a patient safely wait?
• Became the traditional foundation of initially evaluating
patient urgency.
• Maximize getting the right patient to the right resources at
right place and the right time.
 RESEARCH

•ESI proved that it easier to be used by

practicing nurses and it had a faster turn
– over of patients to other units
whatever the case of the patient is.
 BENEFITS
• Rapid identification of patients that need immediate
attention
• Level 1 and level 2 patients can be treated in the high
dependency units of the ED.
• Determination of patients do not need to be seen in
the main ED. (ESI level 4 and 5)
 Emergency Severity Index (ESI) Levels
A. Immediate life-saving intervention required:
airway, emergency medications, or other hemodynamic
interventions (IV, supplemental O2, monitor, ECG
or labs DO NOT count);
• and/or any of the following clinical conditions: intubated, ap
neic,
• pulseless, severe respiratory distress, SPO2<90, acute mental
status changes, or unresponsive.

Unresponsiveness is defined as a patient that is either:

(1) nonverbal and not following commands (acutely); or
(2) requires noxious stimulus.
B. High risk situation -
is a patient you would put in your last
open bed.
• Severe pain/distress is determined by cli
nical observation and/or patient rating of
greater than or equal
to 7 on 0-10 pain scale.
• C. Resources:
• Count the number of different types of re
sources, not the individual
• tests or x-rays
• Examples: CBC, electrolytes and coags equ
als one resource.
• CBC plus chest x-ray equals two resources.
 POCT as: “testing that is
performed near or at the
site of a patient with the
result leading to possible
change in the care of the
patient

blood glucose testing,

blood gas and
electrolytes analysis,
rapid coagulation testing,
rapid cardiac markers
diagnostics, drugs of
abuse screening, urine
strips testing
D. Danger Zone Vital Signs
• Consider up
triage to ESI 2 if any vital sign criterion is exceeded.
Pediatric Fever Considerations
• 1 to 28 days of age: assign at least ESI 2 if temp >3
8.0 C (100.4F)
• 1-3 months of age: consider assigning ESI 2 if temp
• >38.0 C (100.4F)
• 3 months to 3 yrs of age: consider assigning ESI 3 if:
temp >39.0 C (102.2 F),
• or incomplete immunizations, or no obvious source of
fever
Decision Point A: Does the Patient Require Immediate
Life-Saving Intervention?

•If the answer is YES. The triage process is

complete and the patient is automatically
triaged as ESI LEVEL 1
•If NO the patient is put to the next step
ESI LEVEL 1
Examples of patients having ESI level 1
• Cardiac arrest
• Respiratory arrest
• Severe respiratory distress
• SP02 <90%
• Critically injured trauma patent who present unresponsive
• Overdose with RR of 6
• ASRDS gasping pt
• Shock
Decision Point B: Should the Patient Wait?

• The nurse needs to decide whether the patient should

not wait to be seen.
• ESI level 2
3 Broad Questions are used to determine if
the patients meets ESI level 2

• Is this a high – risk situation?

• Is the patient confused,
lethargic or disoriented?
• Is the patient in severe pain or
distress?
 ESI LEVEL 2
• The nurse must obtain pertinent
subjective and objective information.
• The patient can develop sudden
deterioration.
• They are required time sensitive
treatment
Examples of ESI Level 2
• Active excruciating pain
• ACS
• Signs of stroke
• Ectopic pregnancy
• Blunt trauma and peritonitis
• Child is sleeping all the time
Decision Point C: Resource Needs
END