The Emergency Severity Index (ESI) is a validated, five-level triage acuity scale and algorithm used primarily by emergency department (ED) nurses to prioritize patients. Developed by emergency physicians and nurses, with further refinement funded by the Agency for Healthcare Research and Quality (AHRQ), ESI stratifies patients into five groups, from Level 1 (most urgent, requiring immediate life-saving intervention) to Level 5 (least urgent, requiring no resources).
The ESI algorithm is based on four key decision points: 1) Is the patient dying (Level 1)? 2) Is this a patient who shouldn't wait (Level 2)? 3) How many resources are needed (Levels 3, 4, 5)? 4) What are the vital signs?
The ESI is a cornerstone of patient management in many EDs, helping to improve patient flow, rapidly identify high-acuity patients, and inform staffing needs. AHRQ provides the ESI Implementation Handbook and training materials (including slides and DVDs for Version 4) free of charge to facilitate its adoption and implementation into hospital systems.
Key Features and Capabilities:
- Five-level Triage Acuity Scale: Stratifies patients from ESI Level 1 (immediate life-saving intervention) to Level 5 (no resources needed).
- Acuity and Resource-Based Prioritization: Unique in its consideration of both patient acuity and anticipated resource needs for stable, less urgent patients.
- Rapid Identification: Designed for quick, reproducible, and clinically relevant stratification.
- Standardized Decision-Making: Provides a step-by-step guide to clinical decision-making for triage nurses.
- Pediatric Considerations: Later versions (like V4) include refinement of pediatric fever criteria.
