| Vol 3/Issue 1 ~ Triage First Newsletter ~ Winter 2007-08 | |
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Triage Specialist Course
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Newsletter Contents
Front Page Case Presentation Ask the Experts Literature & Research What's New at Triage First Triage First Services
What Is the Reality? Most professionals involved in providing care to ED patients will reject the above supposition outright; however, sometimes what we say is not necessarily reflected in our practice. A study published in Academic Emergency Medicine (May 2007) identified a very concerning statistic: Patients in the study presenting to the emergency department with acute sickle cell pain were assigned a triage acuity of Level 2 on a 5-level acuity scale (Emergency Severity Index) only 27% of the time. The Study The article, “Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease,” presents the results of a study that sought to “characterize the initial management of patients with sickle cell disease and an acute pain episode” and to compare that management with the American Pain Society Guidelines. The study also examined factors associated with a delay in administering analgesics to these patients. Not surprisingly, patients who received lower triage acuities (Level 3 or lower) experienced significantly longer door-to-analgesia times. In addition to discussing the initial management of patients experiencing sickle cell pain, the article also explores the gravity of sickle cell pain and the correlation of life-threatening complications of sickle cell disease. The article leaves the reader with improved better understanding of the rationale for assigning patients with acute episodes of sickle cell pain a higher (level 2) rather than a lower (level 3, 4, or 5) triage acuity. It would serve us and our patients well to remember: “Severe pain from an acute pain episode should be considered a medical emergency.” Reference Tanabe, P. et al, (2007, May) Emergency department management of acute pain episodes in sickle cell disease,” Academic Emergency Medicine, 14(5), 419-425 2007 CDC Report Think You’re Busier Than Ever? Every year since 1992, the CDC (Centers for Disease Control and Prevention) National Center for Health Statistics has issued a report containing the most up-to-date national statistics regarding emergency department care in the United States. The most recent report (released June 29, 2007), titled National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary, puts in writing what we already know—we are busier! In 2005 there were an estimated 115.3 million ED visits compared to an estimated 110.2 million visits in 2004, and the vast majority of the 115.3 million patients arrived via triage. Only 15.5% of patients in 2005 arrived by EMS. It is interesting to note that in the last ten years the number of hospital emergency departments decreased from 4,176 in 1995 to 3,795 in 2005. As ED visits continue to increase, emergency department doors continue to shut. Triage Acuity Designations: 2005 An important change in this year’s report is the addition of a 5th triage level. This is an interesting development as we consider the national trend toward a valid and reliable five-level triage acuity scale. Unfortunately, the report does not clearly identify what methods or criteria were used to determine or assign the triage acuity, leaving the reader with questions: What triage criteria were used? How many hospitals used ESI (Emergency Severity Index) and how many used CTAS (Canadian Triage & Acuity Scale)? How did surveyors incorporate data from emergency departments that use three- or four- level triage acuity scales? The criteria provided for the scale are as follows:
The acuities reflected in the pie graph below are actual acuities assigned at triage. There is no way for the reader to know if these were correct acuities as determined by the appropriate application of a valid and reliable five-level triage scale (ESI or CTAS).
The information contained in this report is extensive and covers a wide range of subjects, including patient demographics, hospital characteristics, most common reason for visit by age group, and many other areas of interest. The report can be easily accessed here, and we encourage you to check it out. Reference Nawar, E.W., Niska, R.W., Xu, J. (2007, June). National hospital ambulatory medical care survey: 2005 emergency department summary (Advance Data from Vital and Health Statistics No. 386). Hyattsville, MD: National Center for Health Statistics.
 Copyright 2008 Triage First, Inc.
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