What Factors Increase the Accuracy and Inter-Rater Reliability of the Emergency Severity Index Among Emergency Nurses in Triaging Adult Patients?

摘要

Within an emergency department, a preliminary patient assessment is performed by the triage nurse to identify life-threatening conditions and prioritize patients according to acuity or level of urgency. The Emergency Severity Index (ESI) triage algorithm is a reliable and valid 5-level triage scale that rates the emergency on a Likert scale ranging from 1 (most urgent) to 5 (least urgent) based on acuity and resource needs. This index was developed in the United States in 1999, by emergency physicians Richard Wuerz and David Eitel. The ESI was designed for triage nurses to rapidly identify those patients who require immediate attention and those who can safely be evaluated in a less urgent setting. It requires the triage nurse to accurately determine patient acuity and make a clinical judgment to maximize the efficacy of the ESI in a short period. The triage nurse's clinical judgment must obtain the right resources for the patient and assign him or her to the right place at the right time. Each patient is unique. The triage nurse must use critical thinking skills to efficiently advocate for patients in a dynamic and, complex environment. The purpose of this article is to clarify the importance of the triage nurse's assessment and identify factors to increase the accuracy of the ESI scale.