Emergency Severity Index

Questions: 1.How does a triage nurse decide which patient gets seen first? 2.How does health disparity affect the triage nurse's decision-making?3.What ethical and moral issues does the triage nurse take into account when making a decision?4.What are triage-level designations? Answers: 1. In an Emergency Room, a patient whose condition is highly critical is seen first. The US Department of Health Human Services has designed the Emergency Severity Index or (ESI) method. This is an efficient tool for enhancing patient care. As per this index there are five levels starting from most urgent to least resource intensive with which the ED patients are rated of their acquity (Chen et al., 2010). Thus the triage decides to give a patient first priority if his or her vital signs are in abnormal conditions or his symptoms, age, or prior medical history indicate the possibility of a life threatening illness (Domagala Vets, 2015). As per the given case study, the triage nurse may decide to provide immediate care to Brent Damascus. It is because this patient is 58 years old and in addition to respiratory difficulties, his medical history indicate of other complications such as headaches, tremors and asthma. He is given first priority over other patient with inhalation injuries because the other patient is 32 years and his medical history does not indicate a likelihood of life threatening illness. Brent is aged and his condition is more delicate compared to other triage patient although both have underwent industrial accident and needs emergency care. Thus, Brent is an immediate patient who cannot wait to die whereas the other patient can be put in delayed category who is severe but stable enough to receive treatment. Thus, the ESI method is highly advantageous for the triage nurses in making rapid clinical decisions, taking clinical initiatives and in clinical research. Such health care policies have positive effect on the emergency care. 2. At the time of assigning the ESI score the Hispanics and the African-Americans are given less priority as a result they are receive delayed care and less likely to be medicated or discharged when compared to the non-Hispanic White patients with similar conditions. In some cases a patient without medical insurance are not triaged emergently in the study (Chen et al., 2010). Therefore such, Racial or ethnic health disparities during ESI scoring may reflect baseline differences in the physical conditions of the patients during ED intake. It may reflect the biases of the provider irrespective of the patients conditions presented at the time of assessment. Hence, it potentially affects the clinical judgment of severity. This may in turn affect the patient outcomes and increase the health care cost. It may also result in patients distrust in particular hospital. Hence, health disparities effect the decision making process of the triage nurses as the triaging occurs in brief encounter with patients in which the differences are likely with significant intra- and interpersonal characteristics. Thus there is a need of intervention strategies focused on increasing adherence to protocol driven triage and management algorithms that could eliminate disparities (Guidet et al., 2013). During the critical clinical decision making process, the triage nurse must communicate in manner that is expected of nursing professionals and is consistent with the evidence based practice. 3. The triage nurse must consider and apply professional nursing ethical standards and principles to the process of decision-making (Gastmans, 2013). The triage nurses must consider the following- Patients Respect for autonomy-in extremely urgent situation patients consent cannot be considered therefore the nurses can provide necessary care. Respecting patient choices as much possible with clear communication in ED is an important way of respecting patients autonomy (Tingle Cribb, 2013) principle of non-maleficence- when unable to prioritize the patients condition it is safe to refer them to other centers instead of causing delay and death beneficence- nurses are morally obliged to prevent or remove harm and promote patient good (Kangasniemi Haho, 2012) Justice- triage nurse must focus on the salvageable patients and minimize the number of deaths. Decision making should be fair keeping in view the resource limitations and patients vulnerability (Cranmer Nhemachena, 2013) Right to Privacy-As per Health Insurance Portability and Accountability Act, nurses must maintain confidentiality of the patient information (Aacharya et al., 2011) 4. There are 5 levels of ESI. The first level- relates to resuscitation indicating requirement of life saving intervention immediately for example cardiac arrest. The second level named emergent indicates high risk of deterioration and critical problem for example asthma attack. The third level is designated as urgent but requires investigation of threat with multiple types of resources such as X-ray for example abdominal pain. The fourth level designated as Less Urgent indicates that the patient is stable with anticipation of one-type of resources for example pain on urination. The fifth level or non-urgent stage indicates that the patient is stable enough requiring oral medications such as rash (Gilboy et al., 2012). References Aacharya, R. P., Gastmans, C., Denier, Y. (2011). Emergency department triage: an ethical analysis.BMC emergency medicine,11(1), 1. Chen, S. S., Chen, J. C., Ng, C. J., Chen, P. L., Lee, P. H., Chang, W. Y. (2010). Factors that influence the accuracy of triage nurses' judgement in emergency departments.Emergency Medicine Journal,27(6), 451-455. Cranmer, P., Nhemachena, J. 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