When patients arrive at a hospital emergency room (ER), they’re usually first seen and assessed by a triage nurse. A triage nurse is a registered nurse who uses a system called the emergency severity index (ESI) to decide and prioritize which patients need to be seen first by an ER physician.
Emergency rooms tend to be busy, so triage nurses perform a critical function.
Not everyone who shows up in an ER has an emergency medical condition. Some patients use ERs for primary care, to treat things like a cold. The standard care requires emergency rooms to make sure that patients with the most severe or life-threatening conditions are seen by a doctor first. Emergency rooms accomplish this by properly using the emergency severity index.
How does the emergency severity index work?
The triage nurse assigns an ESI to patients based on a scale of 1-5. An ESI of 1 is the most urgent, and an ESI of 5 is the least urgent. Here’s a brief explanation of what each ESI means:
• ESI of 1: The patient requires immediate life-saving intervention.
• ESI of 2: The patient has one of three conditions, (1) high risk situation, (2) confused, lethargic, or disoriented, or (3) severe pain or distress.
• ESI of 3: The patient meets the ESI Score 2 criteria, but also has dangerous vital signs (heart rate, respiratory rate, or oxygen saturation) or will require many different resources
• ESI of 4: The patient meets the ESI Score 2 criteria, and will require one resource
• ESI of 5: The patient meets the ESI Score 2 criteria, and will require no resources
Emergency room negligence
When emergency room personnel don’t use the ESI properly, it means that patients with routine, non-urgent conditions may be seen by a doctor before patients with a life-threatening condition, like a stroke. This is a medical error that’s negligent in medical malpractice.
A recent violation report from the Centers for Medicare and Medicaid Services found that the emergency room CHI St. Luke’s Health Baylor College of Medicine Medical Center, located in the Texas Medical Center at 6720 Bertner Dr., Houston, TX 77030, failed to follow well-established ESI procedures.
In an incident that happened in 2019, the Medicare surveyor found that a patient arrived at the emergency room with complaints of lung problems and shortness of breath. The St. Luke’s triage nurse assigned him an emergency severity index of 2, which is the second-most urgent index score.
The ER doctor saw the patient very quickly and ordered tests, radiology imaging and medications. The records reflect that the St. Luke’s nursing staff took 3 hours and 19 minutes to start the medications that had been ordered for this urgent patient. The patient waited in the hallway for 6 hours and 31 minutes before being diagnosed and discharged from the ER.
Meanwhile, while this urgent patient was waiting in the hallway, the triage nurse processed two other patients who arrived at the CHI St. Luke’s Health Baylor College of Medicine Medical Center ER.
The triage nurse assigned one patient an ESI of 5, the least urgent score possible. Yet, he was seen, given a room, treated, and discharged from the hospital just two minutes after the nurses got around to starting the medications with a more-urgent patient that had arrived at the ER much earlier.
The second other patient that the Medicare surveyor cited was also assigned an ESI of 2. This patient, though, was seen, given a room, treated, and discharged from the hospital over an hour before the other ESI 2 patient who had arrived at the ER much earlier and forced to wait in the hall for so long.
The Medicare surveyor cited the hospital with a violation of her concern that there was inadequate registered nursing supervision of nursing care.
It’s a serious problem when emergency room fails to triage patients to make sure the ones in the most danger are seen first. As a former hospital administrator, I see this as a system problem that needlessly puts patients at risk.
If you or a loved one has been seriously injured because of emergency room care, then I encourage you to contact a top-rated Houston, Texas medical malpractice attorney for help in evaluating your potential case.