When a patient enters a hospital emergency department (ED), the first step is triage. The term is derived from the French word trier, meaning to sort or classify patients. This initial assessment is performed rapidly upon arrival to determine the severity of a patient’s condition and the urgency of treatment. Triage establishes the order in which multiple individuals will receive attention from the healthcare team.
The Core Function of Triage in Emergency Care
The purpose of triage is to manage patient flow by prioritizing medical needs over the order of arrival. Emergency departments operate with a finite number of staff, beds, and specialized equipment. Triage serves as the mechanism for allocating these constrained resources to ensure the greatest benefit for the largest number of people.
This prioritization ensures that patients with a life-threatening condition are seen before those with a less severe issue. A person arriving later with a serious stroke or severe trauma will be treated ahead of someone who arrived earlier with a minor sprain. The goal is to identify patients whose condition is most likely to result in significant harm or death without immediate intervention.
The Triage Assessment Process
The triage process is performed by a specialized emergency department nurse trained to make quick, focused clinical judgments. The assessment begins by identifying the patient’s chief complaint, the primary reason they sought emergency care. The nurse then proceeds to a rapid, hands-on physical evaluation focusing on objective data points.
A thorough set of vital signs is collected, including heart rate, respiratory rate, blood pressure, and body temperature. The nurse assesses the patient’s level of consciousness or mental status, as confusion or disorientation can indicate a serious problem. A pain intensity rating, often on a scale of one to ten, is determined to gauge the patient’s distress.
A brief medical history is collected simultaneously to provide context for the current symptoms. Based on these gathered data points, the triage nurse determines if any immediate interventions are necessary, such as placing the patient on a cardiac monitor or starting oxygen therapy. The entire assessment is completed in a few minutes, resulting in the patient being assigned a specific level of urgency.
Understanding Acuity Levels and Wait Times
The triage assessment results in the assignment of an acuity level, which classifies the patient’s severity and dictates their position for treatment. The most common system used in the United States is the five-level Emergency Severity Index (ESI). This index places patients into five categories, ranging from the most urgent to the least urgent.
The assigned ESI level is directly correlated with the anticipated wait time and the allocation of staff resources.
Emergency Severity Index (ESI) Levels
- Level 1: Requires immediate, life-saving interventions (e.g., cardiac arrest or severe respiratory failure).
- Level 2: Assigned to emergent patients in a high-risk situation, showing confusion, or experiencing severe pain, requiring rapid evaluation.
- Level 3: Considered urgent; patients can generally wait up to 30 minutes for a physician, depending on the hospital’s capacity.
- Levels 4 and 5: Designated for less urgent or non-urgent conditions, such as minor injuries or those needing a prescription refill. These patients can safely wait the longest.