The hospital emergency department is one of the most crucial components of the healthcare system. Emergency departments worldwide are reportedly serving increasing numbers of patients who have a range of problems with variable urgency, from mild to life-threatening. Studies show that more than 50 percent of emergency department visits are for non-urgent reasons, leading to unnecessary adverse consequences. Therefore, “triage” is utilized in the hospital emergency department; it is a systematic process that determines the priority of patients’ treatment, to categorize patients based on severity of condition, rather than operating on a ‘first come, first serve’ basis.Triage is French for “sorting and organizing”. The history of emergency medical triage originated as early as the 18th century in the military when it was used to categorize and evaluate wounded soldiers quickly during battle. Today, triage is deeply integrated into healthcare.
Upon arrival to the emergency department, all patients need to be assessed and classified to prioritize those who have the most urgent medical problems and are in need of immediate care. The first stage is the assessment by the hospital triage nurse, which may also be performed by emergency physicians. They will evaluate the patients’ condition and determine the priority for admission to the emergency department and thus treatment.
Various criteria are taken into consideration, including the patient's vitals, degree of injury, neurological deficits, etc. Triage nurses allocate shorter waiting times to the highest priority patients, redistributing patient waiting times according to need. However, only prioritizing urgent patients, would also clog up the system as these complicated cases would fill up rooms with less discharge. There is therefore a delicate balance in the system to allow for efficient patient flow.
There are various triage systems implemented around the world, but the universal goal of triage is to supply effective and prioritized care to patients while optimizing resource usage and timing, in addition to the ability to accurately distinguish between both high and low-urgency patients. For example, in Australia and New Zealand, the Australasian Triage Scale ranges from level 1 to level 5, level 1 being the most urgent and requiring immediate assessment, and level 5 being the least urgent and able to withstand prolonged waiting times. Of additional note, the stress placed on the system also stems from incorrect use of emergency services; patients need to understand —perhaps via educational campaigns—which medical problems are appropriate to present to the emergency department and be informed of the triage system to better appreciate wait times.
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