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GBMC Implements New Triage Tool For Emergency Department Patients
BALTIMORE, Md. – December 18, 2006 - As Greater Baltimore Medical Center nears an all-time high of caring for 60,000 patients in its Emergency Department (ED) in 2006, clinicians are implementing a new tool designed to help triage patients, continue ensuring patient safety, and improve the efficiency of what is often the busiest unit in a hospital.
Based on algorithms and research, the Emergency Severity Index (ESI) divides patients into five acuity levels and helps identify which patients must be seen by a physician immediately and which are stable enough to wait for physician evaluation.
“The ESI scale allows us to rapidly sort patients and also predict how many resources, such as tests, therapeutic interventions and consultations, each patient might require,” said Paula Terzigni, RN, clinical director of the ED. “Using ESI will allow our staff to determine more precisely the priority of patients, helps ensure patient safety and helps expedite patient care.”
ESI levels will be assigned by experienced triage nurses, or by the QuickLook nurse staffing the main lobby, who first evaluates all “walk-in” patients. GBMC was one of the first hospitals in the region to utilize a QuickLook nurse, a position which was initiated in 2004 in an effort to provide patients an initial contact with a medical professional who could determine the level of care they would need.
“Emergency departments across the region and across the nation are facing an ever-increasing demand for service which oftentimes is straining hospital resources,” said John Wogan, M.D., GBMC’s chairman of emergency medicine. “By implementing ESI, we hope to improve the flow and address many of the challenges to better meet the needs of our patients.”
The ESI tool was developed by two physicians in the late 1990s, Richard C. Wuerz, M.D. of Brigham and Women’s Hospital in Boston, and David R. Eitel, M.D. of York Hospital in Pennsylvania. It has since been field tested and revised to meet the needs of today’s emergency departments.
What Is The Emergency Severity Index?
ESI Score (Acuity Level) | Description | Percentage of Patients (Approximate) |
1 | Patient requires immediate life-saving interventions. For example, patient maybe in cardiac or pulmonary arrest and is unresponsive. | 1-3 % of ED Visits |
2 | Patient presents with a high-risk complaint but is stable enough to wait for a bed. They may be confused, lethargic, disoriented, have an active GI bleed, stroke, or are a victim of sexual assault. Pediatric patients with fever, vomiting, diarrhea with signs of dehydration. The patient’s pain is at least 7 on a 10-point scale. | 20-30 % of ED Visits |
3 | Patients presenting that do not meet ESI 1 or 2 criteria, have stable vital signs and are in need of comprehensive evaluation (requiring multiple resources). Most abdominal complaints, pediatric lacerations, complex orthopedic problems. | 30-40% of ED Visits |
4 | Patients with stable vital signs in need of one resource (for example complaining of sore throat and requiring strep culture, or orthopedic injuries requiring only an X-ray. | ESI Levels 4 and 5 combined represent about 20-35% of ED Visits. |
5 | Patients with stable vital signs not requiring minimal resources (for example toothaches, emergency pregnancy prophylaxis, earaches). | ESI Levels 4 and 5 combined represent about 20-35% of ED Visits. |
About GBMC’s Emergency Department
GBMC’s Emergency Department (ED) features separate adult and pediatric treatment areas and an Urgent Care Center, all staffed by board certified emergency physicians and pediatricians. With 43 patient care rooms, the ED will care for more than 60,000 adult and pediatric patients this year.
Designed with a patient and family-focused care environment, patients in the ED are first evaluated by a QuickLook nurse, who initially assesses the patient upon their arrival. Private examination rooms feature televisions, telephones and bedside computers for patient registration and improved medical care. The ED also houses the Sexual Assault Forensic Examination unit, which handles all reported sexual assaults of victims over age 13 in Baltimore County.
The Pediatrics ED combines urgent, emergency care, observation and inpatient care services. Pediatric nurses and physicians follow children along their path of care, and a board-certified pediatrician is on-site around-the-clock.
About GBMC
GBMC includes Greater Baltimore Medical Center (GBMC), Central Maryland’s leading community hospital; Hospice of Baltimore, which provides comfort and care to patients with life-limiting illnesses; the Harry and Jeanette Weinberg Community Health Center, which offers comprehensive health and family services to the residents of East Baltimore; and the GBMC Foundation, which supports the GBMC mission by managing fundraising efforts. The 300-bed Medical Center, located on a beautiful suburban campus, serves nearly 22,000 inpatients annually and provides approximately 50,000 emergency room visits. For more information, go to www.gbmc.org
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 GBMC includes Greater Baltimore Medical Center, Hospice of Baltimore and the Gilchrist Center, GBMC Harry and Jeanette Weinberg Community Health Center and GBMC Foundation.
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