Fixing The Front End: Using ESI Triage To Optimize Flow

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David Eitel
Director of the Health Services Design Section
York Hospital / Wellspan Health

The presenter discusses "The ED Problem", and asks: "What is ED Triage? Why do we do it? What does triage have to do with it?" He reviews ESI's development, what it is, how it's implemented, what you can do with it, and how you can obtain it from the AHRQ.

ED overcrowding has suddenly become part of the healthcare lexicon, everywhere. One team of researchers, The ESI Triage Research Team, decided in the mid-nineties to concentrate their research energies on the front end of the hospital beginning at Emergency Department triage in order to develop solutions for improving patient flow. In doing so they have borrowed heavily from industrial and systems engineering thinking and principles. Over the past ten years they have published a series of formal studies in the peer-reviewed Emergency Medicine literature that has resulted in the Agency for Healthcare Research and Quality ( recommending and releasing in May 2005 the implementation materials for a new five-level ED triage method called The Emergency Severity Index ("ESI"). The researchers involved wish to make the Society For Health Systems aware of the existence of this new ED triage method, deliver some pertinent background information about ESI, discuss the utility of ESI as an ED and Hospital decision-support tool, and review how SHS members can acquire the ESI v.4 Triage Implementation materials and license for their organization from the AHRQ at no cost.