Patient Safety, 2012

Cleveland Clinic Health System Facility Implements AHRQ's Emergency Severity Index

July 2012

Hillcrest Emergency Department (ED)—part of the Cleveland Clinic Health System—implemented AHRQ's "Emergency Severity Index" (ESI) triage system into its split-flow model when it opened a 43-bed Adult and Pediatric ED in 2010.

Maria Roznik, RN, BSN, ED Clinical Instructor for Nursing Education at Hillcrest, says, "Using AHRQ's evidence-based ESI tool allowed us to manage patients in a quick and efficient way. It complemented our split-flow model very well and assists in placing patients in the appropriate patient care zone."

Approximately 40 registered nurses and paramedics at Hillcrest ED were trained in the new process and were required to demonstrate competency in using the ESI algorithm. ED staff sees approximately 60,000 patients a year. They also see about 1,100 emergency medical service visits per month.

AHRQ researchers developed ESI in the late 1990s to prioritize patients into five groups based on patient acuity and the resources needed to treat them. The ESI Triage Group, a group of medical clinicians, managers, educators, and researchers, further refined the algorithm. Triage levels range from Level 1, which includes patients who are unresponsive, not breathing, or intubated, to Level 5, which includes patients who are predicted to require only the taking of a history and a physical.

Roznik says, "Laminated pocket cards were created from the ESI Implementation Handbook to help staff differentiate between the various triage levels. The pocket cards have the ESI triage algorithm on one side and a list of resources on the reverse side. We also enlarged the pocket resource to poster size for our triage rooms to help get patients to the right zones quickly."

Tracking boards in the ED identify individual patient ESI scores, allowing a better balance of staff assignments. Communicating in the same ESI language has made it possible for Hillcrest to better track acuity with appropriate length of stays and disposition.

Roznik concludes, "The improved system identifies patients quickly, and patients are managed more appropriately now."

Impact Case Study Identifier: CQuIPS-12-09
AHRQ Product: Emergency Severity Index
Topic(s): Emergency Medicine
Scope: Ohio

Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 12-0014. Rockville, MD: Agency for Healthcare Research and Quality; 2011. http://www.ahrq.gov/research/esi/esi1.htm

Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care. AHRQ Pub No. 12-0014. http://www.ahrq.gov/research/esi/.

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