Implementation of the emergency severity index in the emergency department: a staff attitude survey from three perspectives

Triage in the emergency department is a necessary tool in order to briefly evaluate and prioritize the acuity of patient symptoms. Despite the reliability and validity of this triage tool in the literature, a successful reorganization of the admission process by implementing the emergency severity index (ESI) could only be reached by the positive perception and acceptance of this tool in the daily routine. Therefore a staff attitude survey was conducted. After implementation of the triage tool, the entire professional staff was interviewed by a standardized questionnaire 6 months later. In the emergency department of the Furth Clinic a tertiary care level III hospital, questions to the emergency service (R), the nursing staff (P) and the physicians (A") before and after ESI implementation and about the training program were evaluated and categorized in the following categories: 0 not true, 1 sometimes true, 2 generally true, 3 always true. Mean values were considered ((x) over bar). Prior to the implementation of ESI most patients were treated according to the waiting time ((x) over bar (A") 1.9; (x) over bar (P) 2.0; (x) over bar (R) 2.3), which led to a perceived dissatisfaction of waiting patients ((x) over bar (P) 2.1). The reorganization by implementing the triage tool was rated positively across all professions ((x) over bar (A") 2.2; (x) over bar (P) 2.7; (x) over bar (R) 2.5), as the interprofessional collaboration and perceptions of actual improvement in emergency service function, effect on own job and effect on patient care were all positively rated ((x) over bar (A") 1.9; (x) over bar (P) 2.2; (x) over bar (R) 2.1). Waiting patients were perceived to feel and act in a more satisfied manner ((x) over bar (P) 2.2). The triage training concept was considered from the triage nursing point of view as reasonable, necessary and effective ((x) over bar (P) 2.7). Both emergency services staff and physicians indicated a general acceptance of the triage tool ((x) over bar (R) 2.2; (x) over bar (A") 2.3) but felt that the individual expertise was not restricted ((x) over bar (A") 0.3; (x) over bar (R) 0.7). All professions agreed the need for triage and the positive indications and effectiveness in optimizing the admissions process in the emergency department. By the stepwise introduction and training concept of ESI a positive perception and acceptance of the triage tool could be achieved.