Document Type : Original Article
Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore, Karnataka, India
Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursing
practice in the emergency department (ED) and validate it with a population-based cohort
using hospitalization and length of stay (LOS) as outcome measures.
Methods: The study included 850 patients, irrespective of age and gender, reporting to
the ED of a tertiary care hospital. Each patient was assessed by the triage nurse as per
the 5-level ESI triage tool and categorized. The number and type of resources used by the
patient, LOS in the ED and the outcome were noted. Data were statistically analyzed by
using RStudio Team software, 2015. A P value of < 0.05 was considered to be statistically
Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%),
ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was
<120 minutes (55.65%). ESI showed a statistically significant association with all the clinical
characteristics, as well as resources used, interventions needed, maximum time allowed
before initiating physician assessment, duration of stay in ED, and patient outcomes
(P=0.000). ESI was found to have a sensitivity of 100% and specificity of 78%.
Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential to
become the standard triage acuity assessment in EDs in India.
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