Triage

How patients are categorised by acuity, the factors that drive that call, and the five Emergency Severity Index levels.

Triage

Triage is a process where patients are categorized based on the potential or severity of their condition. Categories typically range from "immediate" or "resuscitation" for patients requiring immediate life-saving interventions, to "non-urgent" for those with minor complaints or stable conditions that can safely wait for evaluation and treatment. It boils down to: does this patient need immediate interventions or can they wait? Factors that are assessed include: 1) Chief Complaint with Signs and Symptoms a) Chest Pain i) Can be a symptom of various serious conditions like myocardial infarction and pulmonary embolism (Countless other reasons) b) Shortness of Breath i) Can indicate respiratory distress or compromise due to conditions such as pneumonia, asthma or COPD exacerbation, pulmonary edema, or pneumothorax. (Countless other reasons) c) Altered Mental Status i) Can be a sign of neurological dysfunction or systemic illness, including hypoglycemia, stroke or sepsis. (Countless other reasons) d) Trauma i) Patients with severe trauma, such as motor vehicle accidents, falls from high heights, stab wounds or gunshot wounds, require immediate attention to manage life-threatening injuries. e) Stroke Symptoms i) Patients with sudden-onset focal neurological deficits, such as facial droop, arm weakness, slurred speech or unilateral numbness. f) Fever in Pediatric Patients i) Can be a sign of a serious underlying infection so make them a priority as pediatric patients may have limited or underdeveloped immune systems 2) Vital Signs a) Vital signs help assess a patient's overall status. Abnormal vital signs, such as tachycardia, hypotension, tachypnea, or hypoxemia, indicate a serious issue that needs to be addressed. This further validates a need to place a patient as a higher priority to receive attention and interventions. b) For example, if a patient presents with shortness of breath with a respiratory rate of 34 and an SPO2 of 85%, it warrants the triage nurse to place the patient as a higher priority, immediately notifying the charge nurse of the need for this patient to be placed in a room for immediate stabilization interventions. Another example would be if a family member brings a patient for Altered Mental Status and decreased PO intake with a heart rate of 150's and bp of 84/55. This would require the patient to receive immediate attention. 3) Potential for Deterioration and Time Sensitive Conditions a) Stroke Symptoms b) Anaphylaxis and Allergic Reactions c) Suicidal and Homicidal Ideation d) ACS (Stemi, Nstemi, Unstable Angina) e) Conditions that are time-sensitive such as these should be assigned with a triage level that places them at a higher priority. 4) Risk Factors a) Age i) Neonates, children and the elderly should be placed as a priority due to the potential for serious injury. b) Medical History i) Diabetes, hypertension, known heart disease, increased cholesterol, smoking, or immunosuppression, place the patient at an increased risk for complications. c) Medications i) Patients presenting with issues of high risk medications like blood thinners, insulin, opioids, immunosuppressants and pediatric medications should be assessed more rapidly to ascertain the risk for serious injury. d) Recent procedures and surgeries i) Recent surgeries or invasive procedures may place patients at increased risk for complications such as infection and bleeding. e) Social Risk Factors i) Alcohol Use ii) Smoking History iii) Drug Use Putting all the details and information together is the key. For example, an elderly patient with chest pain and stable vitals will be assigned a higher priority than a patient in their 20s with the same chief complaint and vital signs. To simplify it, again, can this patient wait to be seen? should they wait to be seen? Should they skip the line? Should they receive immediate care? Should they be seen first in the fast track area by a provider? Or should they be placed in a resuscitation room for immediate critical care and life saving interventions?

Emergency Severity Index

There are many triaging algorithms used in Emergency Departments. We will only cover the Emergency Severity Index (ESI) here. If your ER uses a different system, please become familiar with it. Although many principles are interchangeable. The Emergency Severity Index (ESI) is a five-level triage algorithm used to prioritize patients in the emergency department (ED) based on the acuity of their condition and the anticipated resource needs. 1) Level 1 - Immediate a) Patients with life-threatening conditions requiring immediate interventions. These patients should be seen immediately. b) Examples: Cardiac and respiratory arrest, severe trauma, active hemorrhage, acute myocardial infarction, stroke with neurological deficits, severe respiratory distress. 2) Level 2 - Emergent a) Patients with potentially life-threatening conditions. These patients are unstable and may deteriorate without prompt medical attention. These patients should be seen by a provider within 10 minutes. b) Examples: Chest pain with suspected ACS, asthma exacerbation, moderate trauma, and so forth. These patients will have unstable vital signs. 3) Level 3 - Urgent a) Patients with stable vital signs who do require prompt assessment and intervention, however, the condition is not life-threatening at that moment in time. These patients should be seen within 30 minutes. b) Examples: Abdominal pain, asthma or COPD without change in vital signs, possible fractures, skin infections like cellulitis. 4) Level 4 - Less Urgent a) Stable patients, can wait for up to 1 hour. No life threatening conditions. b) Examples: Lacerations requiring sutures, sprain or strain, minor burns, or mild pain. 5) Level 5 - Non-Urgent a) Do not require immediate attention, no life threatening condition, may wait for an extended period of time. b) Examples: Cold symptoms, medication refills, suture removal. The ESI algorithm is designed to efficiently categorize patients according to their level of urgency, ensuring that those with the most critical conditions receive timely care.

Updated 30 Aug 2026