Emergency triage refers to the process of classification of patients on the initial arrival at the emergency room by the professional and sophisticated triage nurse, using standard methods to quickly assess and determine the priority of patients’ treatment according to the severity of their condition.
It helps the emergency room to divert and dispose patients, so that critical patients could get immediate treatment. Emergency triage is divided into four major categories, including non trauma adult, non-trauma children,trauma, and environment.
二、 The purpose of triage.
- To quickly identify whether the patient has an emergency or life-threatening condition.
- To assess the severity and priority classification.
- To direct the patient to the appropriate medical area.
- To determine the interval of reassessment of the patient according to the level of classification while waiting.
三、 The basis for triage.
When the patient enters the emergency room, the patient is quickly inspected, and the vital signs are measured by the triage nurse. At first,the most appropriate chief complaint of the patient is selected based on the patient's statement, and then the primary and secondary adjustment variables are used to determine the severity and urgency of the patient's condition. Primary adjustment variables include respiratory distress,hemodynamics, awareness, body temperature, the degree of pain, high
risk of injury (trauma patients). Secondary adjustment variables are the degree of each primary variable, such as mild to severe respiratory distress, low to high-grade fever, whether the symptoms are present or not, the degree of pain and so on.
四、The classification of triage.
According to the new five-level classification of triage criteria published in 2010, the patient is classified as resuscitation, emergent, urgent, less urgent, and non-urgent to get appropriate treatment. The first level of emergency (RESUSCITATION) should be treated immediately; the second level of emergency (EMERGENT) may wait for 10 minutes to get reassessment or treatment; the third level of emergency (URGENT) may wait for 30 minutes; the fourth level of emergency (LESS URGENT) may wait for 60 minutes; and the fifth level of emergency (NON URGENT) may wait for 120 minutes. Thanks to the detailed content of classification of the new triage criteria, by computer assistance,the triage nurse can objectively and accurately determine the severity and priority of the patient, so that each patient can receive the most appropriate treatment by priority. (Table 1)
Table 1: Taiwan Triage and Acuity Scale (TTAS)
|
Triage Classification
|
Condition
|
Definition
|
|
First level
|
Resuscitation
|
- Critical, life or limb-threatening conditions.
- Require immediate treatment.
|
|
Second level
|
Emergent
|
- Conditions potentially critical to life, limbs, and organ functions.
- Require reassessment or to be quickly controlled and treated within 10 minutes.
|
|
Third level
|
Urgent
|
- Potentially deteriorating conditions.
- Patients may have symptoms or signs of discomfort, impacting on daily activities.
- Require reassessment or emergency treatment within 30 minutes.
|
|
Fourth level
|
Less urgent
|
- Conditions may include acute episodes of chronic diseases, or complications associated with certain diseases.
- Require reassessment or treatment in 60-120 minutes to avoid deterioration or gain recovery.
|
|
Fifth level
|
Non urgent
|
- A non-emergency condition.
- Require reassessment or make differential diagnosis or referral to out-patient department in 120 minutes or more to avoid future complications.
|
五、 Conclusion.
Nowadays, it is quite a serious problem for most of hospitals in Taiwan that emergency rooms are overcrowded with patients. Most of the patient and family, who could not realize not only the limited resources of emergency medical system but also the meaning of triage, are often unable to wait patiently, impetuously rush into clinic area and even act with rage since they feel they have been waiting too long. It could disturb and distract the medical staff, resulting in interruption and having a great impact on the treatment of critically ill patients.It is crucial to maintain the quality of medical care as the well-being for the people in developed countries that visiting the hospital of each grade by the severity of condition and waiting patiently at emergency room by triage classification level to make time and resources for critically ill patients. In any case, based on the new five-level classification of triage,the emergency medical staff will provide the most appropriate service and
resources for the patient as best and fast as possible.
六、Reference
- Hileman E., & McKain D. (2019). Implementation of Emergency Severity Index Training to Improve Accuracy of Triage Levels.Doctor of Nursing Practice Projects.44, 1-6.
- Moura B.R.S., &Nogueira L.D.S. (2020). Performance of the rapid triage conducted by nurses at the emergency entrance. Rev Lat AmEnfermagem., 28:e3378.
- Shivanna H.K., Ramesh A.C., & M Rangaswamy K.M. (2022).Implementation and evaluation of the five-level emergency triage(emergency severity index tool): A hospital-based, prospective,observational study. Journal of Emergency Practice and Trauma.;8(1), 43-48.