Implementation and evaluation of the five-level emergency triage (emergency severity index tool): A hospital-based, prospective, observational study

Objective: To implement the 5-level Emergency Severity Index (ESI) triage tool into nursing practice in the emergency department (ED) and validate it with a population-based cohort using hospitalization and length of stay (LOS) as outcome measures. Methods: The study included 850 patients, irrespective of age and gender, reporting to the ED of a tertiary care hospital. Each patient was assessed by the triage nurse as per the 5-level ESI triage tool and categorized. The number and type of resources used by the patient, LOS in the ED and the outcome were noted. Data were statistically analyzed by using RStudio Team software, 2015. A P value of < 0.05 was considered to be statistically significant. Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%), ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was < 120 minutes (55.65%). ESI showed a statistically significant association with all the clinical characteristics, as well as resources used, interventions needed, maximum time allowed before initiating physician assessment, duration of stay in ED, and patient outcomes (P = 0.000). ESI was found to have a sensitivity of 100% and specificity of 78%. Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential to become the standard triage acuity assessment in EDs in India.