Designing and Implementing an Electronic Triage System Based on ESI Model

Abstract

Abstract Introduction Triage in Emergency Departments (EDs) of the hospital is the process by which the ED visitors are prioritized. This prioritization aims at minimizing the adverse effects of delayed care. Besides the growing use of computers in other parts of the healthcare system, electronic triage systems are developed in various countries. In addition to ability of these systems in performing the triage electronically, they are capable of giving reports which these reports can be used to allocate the resourses and manage the ED more efficiently. Aim The aim of this study was to develop and implement an electronic model for ED triage based on the Emergency Severity Index (ESI). Then to assess validity and reliability of it and to compare it with the routin triage performed in the participating ED. Another aim was to obtain the ED staff's satisfaction and perception on the model. Methods Initially the electronic model of ED triage was developed based on the latest version of the ESI triage handbook (fourth version). Then three months after implementation in Imam Reza Hospital of Tabriz, its validity was assessed and compared with the routin triage using the inhospital mortality, hospitalization, cost of services, length of stay in ED, and the number of resources used for patients. To assess reliability the triage categories assigned by triage nurses were compared with those assigned by the ED physicians. Also the time spent in triage in both electronic and routin methods was measured and compared. The opinions and satisfaction of the ED personnel on the electronic triage collected and analyzed too. Results The electronic model was named Electronic Triage System (ETS). The routin triage was valid in predicting in-hospital mortality, hospitalization, cost of services, and number of resources. But it was unable to predict the ED length of stay. The results showed that the ETS was valid in predicting all five above mentioned outcomes. Reliability of both routin and electronic triages was almost similar. The ED staff expressed average satisfaction. Punching patient data on ETS took more time than the routin (paper based) triage. Conclusion This is the first time in the country that an intelligent Electronic Triage System is developed to be used in hospital EDs. Considering similar reliability of electronic and paper triages, more validity of the ETS and its capability in reporting, facilitating the supervision and monitoring, facilitating data retrival and providing the triage nurses with feedback, all encourage us to suggest the use of the ETS in EDs. The experience of implementing the ETS in this study can be a baseline for future studies around the country. Also the comments of system users can be used to improve the system and make them to feel more ownership on it. Improving the ED staff's skill in using computer can reduce the amount of time that they spent for triaging patients.