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The case for a universal, valid, reliable 5-tier triage acuity scale for US emergency departments*,**

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Triage systems

A triage system is the basic framework with which patients are sorted, using an acuity rating scale. In the most simplistic form, a “traffic director” greets and directs the patient to the correct treatment area based on an initial impression. This system was used by 4.8% of responding emergency departments in the ENA 1998 database5; however, most emergency departments use 1 of 3 other triage systems: spot check, comprehensive, or 2-tier.

Acuity scales

The ideal—every patient being immediately seen in the treatment area—is just not feasible. Therefore, the focus usually becomes the ordering of patients by acuity ratings within the system.

Five-tier acuity ratings

An awareness of the added precision and consistency of a 5-tier acuity rating system is growing. A 1996 ENA study found that 10% of the responding emergency departments already used some form of a 5-level acuity rating,11 although considerable individual and regional variations exist.

Internationally, national standardized 5-level systems with proven reliability and reproducibility are being instituted. To aid comparison, descriptions are made by 5 numerical levels, with 1 being the highest

Conclusion

“The music has changed, so must the dance” is an African proverb. So it is with the US ED triage acuity systems. Studies show that the widely used 3-tier system is ineffective in meeting the needs of today's burgeoning ED patient population. The solution seems to lie not in attempting to improve individuals' performance within the same system but in embracing an improved process.

The call for change is clear, even though the system that is best suited for use in the United States is not as

Acknowledgements

I acknowledge with gratitude the input of Debbie Travers, RN, MSN; the late Richard C. Wuerz, MD; David Eitel, MD, MBA; Nicki Gilboy, RN, MS; Janet Marsden, MSc, BSC, RGN, OND, MiMgt; Lisa Hadfield-Law, RNG, A/E Cert.; and Brian Dolan, BSC (HONS), RMN RGN, CHSM.

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  • Cited by (47)

    • Emergency nurses’ knowledge and experience with the triage process in Hunan Province, China

      2017, International Emergency Nursing
      Citation Excerpt :

      The Australasian Triage Scale was first developed and implemented in Australia in 1993 and was substantially revised in 2000. It is also a 5-point triage scale, with patients allocated to different categories based on their need for time-critical intervention, the potential threat to their life from their presenting problem and the need to relieve suffering [2,3,6]. In mainland China, most EDs do not have a dedicated emergency triage system in place and there is a shortage of appropriately trained triage nurses [1]; however, large urban hospitals are increasingly adopting triage scales [7].

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    *

    For reprints, write: Polly Gerber Zimmermann, RN, MS, MBA, CEN, 4200 N. Francisco, Chicago, IL 60618; E-mail: [email protected]

    **

    J Emerg Nurs 2001;27:246-54.

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