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  • Noma Lifa

The Emergency Severity Index (ESI)

Updated: Apr 27, 2023

Attorneys - Does your client complain that he or she did not receive prompt care after presenting to the Emergency Department? Does your client feel that their complaint was not taken seriously, and that other people were taken to the back way faster than they? Well, there is a reason for that, and it is because of triage protocols - the Emergency Severity Index (ESI)


The Emergency Severity Index (ESI) is a tool for use in emergency departments triage. The ESI triage algorithm yields rapid, reproducible, and clinically relevant stratification of patients into five groups, from level 1 (most urgent) to level 5 (least urgent). The ESI provides a method for categorizing ED patients by both acuity and resource needs. This tool was developed in 1998 by two Emergency physicians, Dr. Richard Wuerz and Dr. David Eitel. The algorithm has been refined over the years and remains a crucial tool in all emergency departments in order to provide quality of care.


The purpose of triage in the emergency department is to prioritize incoming patients and to identify those who cannot wait to be seen. For example, patients presenting with chest pain, stroke symptoms or in respiratory distress, etc. The triage nurse performs a very brief but focused assessment and then assigns an acuity level, which is a quick measure of how long an individual patient can safely wait for a medical screening, examination and/or treatment.


Use of the ESI for this rapid sorting can lead to improved flow of patients through the ED. For example, level 1 and 2 patients can be taken directly to the treatment area for rapid evaluation and treatment while lower acuity patients can safely wait to be seen. Other benefits of the ESI include determination of which patients do not need to be seen in the main ED and those who could safely and more efficiently be seen in a fast-track or urgent care area. For example, in many hospitals, the triage policy stipulates that all ESI level-4 and level-5 patients can be sent to either the medical fast track or minor trauma areas of the ED.


Please call on Lifa's Legal Nurse Consulting to assist you with any and all of your medical malpractice cases. We help legal teams, governmental agencies and insurance companies to navigate the medical record. With our knowledge of the Emergency Room and field experience, we can help identify deviations to the standard of care that's expected in the Emergency Room.


Schedule a complimentary consultation so we can save you time and money on your cases.


Source: Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4: Implementation Handbook, 2012 Edition.

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