Posted: January 12th, 2023

Existing Practices in Emergency Care

Existing Practices in Emergency Care
Emergency care systems around the world utilize triage protocols to prioritize patients based on acuity and ensure those with life-threatening illnesses or injuries receive rapid medical attention (Beveridge et al., 2019). Triage aims to sort patients into categories of nonemergent, emergent, urgent emergent, and resuscitative or trauma-level status. Staff then treat patients according to established guidelines that maximize health outcomes given available resources.
Triage protocols have evolved significantly in recent decades. Earlier triage models relied primarily on subjective clinical judgement, which risked inconsistency and human error (Wuerz et al., 2001). Modern triage systems incorporate objective vital signs measurements and validated assessment tools to promote standardized, evidence-based decision making. For instance, the Emergency Severity Index (ESI) algorithm factors a patient’s chief complaint, vital signs, mental status, and simple supplemental tests into a 5-level triage stratification (Gilboy et al., 2011). ESI and similar instruments have demonstrated reliability and predictive validity for resource utilization, making triage more precise.
While triage protocols aim to prioritize the sickest, emergency departments worldwide still face challenges with patient flow and throughput (Hoot & Aronsky, 2008). Boarding of admitted patients in the emergency setting remains common due to inpatient bed shortages. This contributes to emergency room overcrowding and prolonged wait times, compromising quality of care (Sprivulis et al., 2006). Some hospitals have instituted measures like dedicated inpatient hospitalists, accelerated discharge processes, and expanded step-down units to help alleviate boarding and create capacity (Asplin et al., 2003). Further optimization of hospital operations and healthcare systems overall will continue to be important for supporting effective emergency care.
In summary, established triage protocols and assessment tools guide prioritization and treatment of patients presenting to emergency settings. While standardizing decision making, current practices still grapple with issues of patient flow, crowding, and timely access to care. Ongoing efforts aim to enhance system efficiencies and maximize health outcomes given constrained resources.
Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo, C. A. (2003). A conceptual model of emergency department crowding. Annals of emergency medicine, 42(2), 173–180. https://doi.org/10.1067/mem.2003.302
Beveridge, R., Ducharme, J., Janes, L., Beaulieu, S., & Walter, S. (1999). Reliability of the Canadian Emergency Department Triage and Acuity Scale: Interrater agreement. Annals of emergency medicine, 34(2), 155–159. https://doi.org/10.1016/s0196-0644(99)70271-4
Gilboy, N., Tanabe, T., Travers, D., & Rosenau, A. M. (2011). Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12-0014. Agency for Healthcare Research and Quality.
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: causes, effects, and solutions. Annals of emergency medicine, 52(2), 126–136.e1. https://doi.org/10.1016/j.annemergmed.2008.03.014
Sprivulis, P., Da Silva, J., Jacobs, I., Frazer, A., & Jelinek, G. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Medical journal of Australia, 184(5), 208–212. https://doi.org/10.5694/j.1326-5377.2006.tb00344.x
Wuerz, R. C., Milne, L. W., Eitel, D. R., Travers, D., & Gilboy, N. (2000). Reliability and validity of a new five-level triage instrument. Academic Emergency Medicine, 7(3), 236–242. https://doi.org/10.1111/j.1553-2712.2000.tb02037.x

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