Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

Adler, David; Abar, Beau; Durham, Danielle D.; Bastani, Aveh; Bernstein, Steven L.; Baugh, Christopher W.; Bischof, Jason J.; Coyne, Christopher J.; Grudzen, Corita; Henning, Daniel J.; Hudson, Matthew F.; Klotz, Adam; Lyman, Gary H.; Madsen, Troy; Pallin, Daniel J.; Reyes‐Gibby, Cielito C.; Rico, Juan Felipe; Ryan, Richard J.; Shapiro, Nathan I.; Swor, Robert A.; Thomas, Charles R.; Venkat, Arvind; Wilson, Jason; Yeung, Sai Ching Jim; Caterino, Jeffrey M.

doi:10.1016/j.jemermed.2019.05.023

Cited by 24 publications

(29 citation statements)

References 20 publications

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“…The emergency severity index (ESI) was obtained from the medical record for all ED patients. ESI was not available in the NCCHIC; as a result, it was calculated for NCCHIC patient visits via information obtained by chart review [12,13].…”

Section: Methodsmentioning

confidence: 99%

A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study

Bischof

Bush

Shams

et al. 2021

Support Care Cancer

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Purpose Patients with cancer often experience medical events that require immediate evaluation. These evaluations typically occur in an emergency department (ED), but there is increasing interest in providing this care in other settings. We report on a novel care model whereby a nursing hotline is used to triage patients to the ED or to the North Carolina Cancer Hospital Infusion Center (NCCHIC). Methods A retrospective study of adult patients with a neoplasm diagnosis seeking acute care at a large academic hospital pre-and post-initiation of the novel care model in January of 2016. Patients were identified by querying the electronic medical record and clinic administrative data during matched 6 month pre-and post-periods. Results During the pre-initiation period, 1346 patients visited the ED on 1651 occasions (76.1% admission rate). In the post-initiation period, 1434 patients visited the ED on 1797 occasions (81.5% admission rate), and 246 patients visited the NCCHIC on 322 occasions (68.9% admission rate). The emergency severity index (ESI) in the pre-initiation ED group was primarily ESI 2 (30.6%) and ESI 3 (65.4%). In the post-initiation ED group, the ESI was similar (32.6% ESI 2 and 64.2% ESI 3). In contrast, the NCCHIC predominantly treated lower acuity patients (65.8% calculated ESI of 4/5). Conclusions This model demonstrates a multidisciplinary partnership to providing acute unscheduled care for patients with cancer. In the early implementation phase of this model, approximately 15% of patients, generally of lower acuity, were seen in the NCCHIC.

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Section: Methodsmentioning

confidence: 99%

A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study

Bischof

Bush

Shams

et al. 2021

Support Care Cancer

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“…The determination of emergency treatments may depend on a complex interplay of the care providers (hospital levels) and the acuity of the claimed disease as well as patient characteristics [17]. Thus, emergency treatment served as a dependent variable, while triaged levels were employed as independent variables.…”

Section: Methodsmentioning

confidence: 99%

Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations

Chen

et al. 2020

IJERPH

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Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). Methods: A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient's residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. Results: All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. Conclusions: This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect.

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“…The Emergency Severity Index, Version 4 (ESI) has been validated for triaging adults with active cancer in the ED. 18 We suggest an initial management algorithm based on the triage of presenting acuity to guide emergency physicians in their approach for evaluation and management ( Figure 3). For ESI = 1 ( Figure 3A), resuscitation and stabilization of the patient follow the Advanced Cardiac Life Support protocol.…”

Section: Triage and Differential Diagnosismentioning

confidence: 99%

Diagnosis and management of immune‐related adverse effects of immune checkpoint therapy in the emergency department

et al. 2020

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Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

Cited by 24 publications

References 20 publications

A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study

A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study

Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations

Diagnosis and management of immune‐related adverse effects of immune checkpoint therapy in the emergency department

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