Reliability and Validity of Scores on the Emergency Severity Index Version 3

Tanabe, RN Paula; Gimbel, Rick; Yarnold, Paul R.; Kyriacou, Demetrios N.; Adams, James G.

doi:10.1197/j.aem.2003.06.013

Cited by 233 publications

(130 citation statements)

References 16 publications

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“…[22] One of the initial validation studies using a retrospective design similar to our study and ESI v3, showed an 80% accuracy rate, but it was done ten months after the implementation of the system with an ongoing quality improvement process noting mis-triages. [18] There is a wide range of results regarding reliability (from fair to very good) and validity of triage systems in the literature; with ESI and CTAS having the highest reported reliability. [12,23,24] However, a systematic review of different triage systems suggests there is limited and insufficient evidence for assessing validity and reliability in many triage scales, with variability in the methods and measurements (kappa, weighted kappa, Pearson).…”

Section: Discussionmentioning

confidence: 99%

“…[3,29] In addition to the live training and case scenarios, providing monthly summarizes of misclassifications as an educational tool would be beneficial, as was done in the Tanabe study. [18] Other suggestions include obtaining training by a mentor, additional objective competency training, resource utilization training, continuing education, and monthly or at least quarterly feedback. [32] It is important to note that it is not possible to completely eliminate over and under triages, and as such there is no standard of what is acceptable.…”

Section: Discussionmentioning

confidence: 99%

“…[15,16] Many studies have shown that ESI and other triage systems are reliable (inter and intra observer variability) and valid (predicting "true" urgency). [5,12,[17][18][19] There is a dearth of information on optimal training for accuracy and need for retraining.…”

Section: Introductionmentioning

confidence: 99%

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Emergency severity index version 4 during the first year of implementation at an academic institution

Dalawari

Sanning

Pan

et al. 2015

JHA

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Background: The Emergency Severity Index (ESI) version 4 (v4) is a triage system based on vital signs, potential limb or organ threat, as well as expected resources needed in the emergency department (ED). Objective: The purpose of this study was to examine accuracy and misclassification rate of ESI triage over one year following implementation. Methods: This was a retrospective analysis of ED encounters from January 2011 to 2012. Charts were selected in one-week intervals every 12 weeks for one year (months 1, 3, 6, 9, and 12). Each encounter was reviewed to determine post hoc ESI level based on care in the ED. Descriptive statistics was used to compare the agreement between initial triage and post hoc ESI levels. Sensitivity and specificity for each level was determined. Kruskal Wallis test (KW) and Mann Whitney U (MWU) was used to assess differences in initial versus post hoc ESI levels by month to explore change in accuracy over time. Results: Five hundred and sixty separate ED encounters were included. Agreement was observed in 301 triage encounters (53.8%). Overestimation of the triage level occurred in 131 (23.4%) encounters, while the triage level was underestimated in 128 (22.9%) encounters. There was a significant decline in accuracy during the year (KW = 10.2; p = .037); with the greatest drop between month 1 and 9 months (MWU 4,859; p = .035). Sensitivity ranged from 24% to 76% and specificity ranged from 61% to 99%, based on ESI level. Conclusions: Enhanced education and quality improvement process is necessary to improve overall accuracy rates at this site.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Emergency severity index version 4 during the first year of implementation at an academic institution

Dalawari

Sanning

Pan

et al. 2015

JHA

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“…It sorts patients into one of five severity categories, ES1 through ES5, with ES1 indicating patients who have the most immediate need for medical care. It was first reported in 2000 (Wuerz et al, 2000) and was found to be most valid for the two highest severity categories (Tanabe et al, 2004 Correct application of any triage instrument facilitates judicious allocation of ED resources so that the most severely ill or injured patients can receive safe and timely care (Tanabe et al, 2004). Using this system, patients assigned to categories ES4 and ES5 are deemed to be stable and need treatment that could be delayed; thus the needs of patients assigned to ES4 and ES5 categories are considered nonurgent.…”

Section: The Emergency Severity Indexmentioning

confidence: 99%

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

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DEDICATIONThis work is dedicated to my family. My husband, Gary DeWood, has provided far more encouragement and support throughout the duration of this project than either of us thought would be necessary, and has done so with grace and forbearance. My children, Patricia, Dale, and Kathryn, made many sacrifices and contributions that were material to my being able to be in school, for which I am more grateful than I can express. While it may be impossible to quantify the benefits of prayer, I am certain that the maximum of those benefits have been bestowed on me due to the fact that my mother, Alice Davis, has made countless petitions heavenward on my behalf. (Any answering of prayers that has occurred is because my mother deserves to have her prayers answered, not because I do. In any case, because of the probable reduction in requests for help, I dare say even God is relieved that my dissertation is finally complete.) The example set by my late father, Dr. Dale Davis, whose work as an adult PhD candidate I remember, exhorted me to sustain my efforts during times when it seemed that this enterprise was ill-advised for anyone who could be otherwise gainfully employed. iv ACKNOWLEDGEMENTSFirst and foremost, I thank Dr. James Vaden for being my advocate, providing encouragement, and for being a mentor without peer. I do not know by what luck it is that I was able to find such a friend.I would also like to thank all the faculty members who gave me instruction and guidance. In particular I appreciate the efforts of my committee members, Drs. Lawrence Brown, Cyril Chang, Joy Clay, Doug Imig, and Junling Wang, but most especially for those of Dr. Lawrence Brown, who had the unenviable task of assuming chairmanship of my dissertation committee late in the game. No one knows better than I do that accomplishing all that is required to obtain a Ph.D. cannot be done alone.v ABSTRACT Purpose. The purpose of this study is to examine the influence of patientperceived provider availability on nonurgent emergency department use (NUEDU). The study population consists of a nationally-representative population of non-elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).Methods. Data were obtained from a nationally-representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient-perceived provider availability was based on patient report of how difficult it was to contact their RSC by phone for medical advice during office hours (Regular Hours Contact), how difficult it was to reach their RSC after hours in case of an urgent problem (After Hours Contact), and whether their RSC had office hours at night or on weekends (Night or Weekend Hours). Multiple logistic regression analysis was used to determine whether the patient-reported provider ava...

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“…The Emergency Severity Index (ESI) is a tool that can be used to help triage patients upon arrival at the ED [31]. The ESI uses a 0-5 scoring system, with 0 being the most severe injury or illness (Fig.…”

Section: Periprocedural Care Of the Patientmentioning

confidence: 99%

Recommendations for Endovascular Care of Stroke Patients

et al. 2017

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The field of neurointerventional radiology (NIR) therapy, including acute ischemic stroke intervention, endovascular intracranial aneurysm management, and treatment of intra- and extracranial large-vessel disease, has evolved over the past 18 years. To support this specialized advanced care requires nursing standards of care for staff to provide direct patient care in NIR suites and intensive management of this high-risk patient population. The intent of this paper is to provide a complementary document for the Stroke Interventional Laboratory Consensus (SILC) statement that will specifically address the nursing standards of care for patients in an NIR suite.

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Reliability and Validity of Scores on the Emergency Severity Index Version 3

Abstract: Scores on the ESI assigned by nurses have excellent interrater reliability and predict hospital admission and location of admission.

Cited by 233 publications

References 16 publications

Emergency severity index version 4 during the first year of implementation at an academic institution

Emergency severity index version 4 during the first year of implementation at an academic institution

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

Recommendations for Endovascular Care of Stroke Patients

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