Multi-site Evaluation of ESI Triage Levels and Medication Administration Times
Loading...
Date
2015-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Background: The Emergency Severity Index (ESI) is an evidence-based system of triaging patients into varying levels of acuity based on their condition to assure that a provider sees the most acute patients first. Pain is the most common reason that patients present to the Emergency Department (ED) and accounts for up to 78% of visits- meaning that the ability to recognize, classify and treat pain appropriately is very important in the ED today.
Purpose: The purpose of this study will be to evaluate the relationship between nurse-assigned ESI scores (a measure of triage acuity), selection of pain medication, and timeliness in pain medication administration.
Sample: A quantitative, retrospective study was used to study N = 1,966 patients with chief complaints of pain in a large urban ED (>90,000 visits/year) in a Midwestern city and a moderate sized but busy (>60,000 visits/year) ED in a small, rural Appalachian town were combined with prospective ED conditions data collected hourly over a 3 month period in 2013.
Procedure: In the prospective phase, data were collected about conditions within the ED (including total ED census, number of ESI 1, 2 and 3 patients, etc.) by trained clerical staff at the beginning of each hour for 24 hours a day for three months. In the retrospective phase, patient visit data was audited from the electronic medical record and collected. Finally, the prospective and retrospective data sets were combined to match each patients' ED visit with the ED conditions data at the time of their visit.
Results: When the type of opioid was compared across ESI triage categories, there was a statistically significant difference in proportions of subjects receiving each medication (χ2 (12) = 394.03, p <.001.). Subjects triaged at ESI 2 (more acute on the ESI 1-5 scale) were more likely to receive a stronger opioid – hydromorphone – than hydrocodone, for example. No statistically significant differences were noted when timeliness in pain medication administration was compared across the ESI triage categories.
Implications for Practice: ESI triage level corresponded well to the type of opioid administered, with lower acuity patients more often receiving hydrocodone and more acutely ill patients receiving hydromorphone. ESI triage level did not correspond with timely administration of any opioid medication, however, likely due to a “fast track” pathway where low-acuity patients are quickly treated and released. Additional research is needed to clarify the relationship between ESI triage level and timely treatment of pain in EDs.
Description
Honorable Mention- The Denman Undergraduate Research Forum
Keywords
opioid, emergency department, emergency severity index, triage