Using ESI to Triage Oncologic Emergencies Expedites Patient Care, Flow
WASHINGTON, DC—Implementation of the Emergency Nurses Association-recommended Emergency Severity Index (ESI) expedited patient care and flow within an urgent care center of a comprehensive cancer center, according to research presented at the Oncology Nursing Society (ONS) 38th Annual Congress.
Historically, patients were triaged using a three-tiered scale based on chief complaint, reported Catherine Licitra, RN, MA, of Memorial Sloan-Kettering, New York, NY[DAH1] . “The majority of patients were classified as urgent, but nurses struggled to assign patients or verbalize the acuity of the care needed.”
In 2011, the hospital recognized that the triage system for the unit, which averages 24,000 patient visits annually for care ranging from treatment-related side effects to oncologic emergencies, “provided limited data that was subjective and nonreproducible,” she noted. “The nurses needed a better mechanism to triage patients using an evidenced-based tool that balanced emergency interventions with oncology care.”
The algorithm used by the ESI yields rapid, reproducible and clinically relevant classification of patients into 5 levels, from Level 1, most urgent, to Level 5, least urgent. Oncology patients' chief complaints are triaged by both acuity and resource needs. The group implementing the ESI “reviewed common oncologic complaints and categorized them into one of the 5 levels,” Licitra stated. “Patients were triaged based on chief complaint, vital signs, and oncologic history.” All registered nurses were trained and reviewed patient case scenarios to establish ESI competency.
Throughout 2012, data were captured monthly to identify the case mix of patients presenting to the urgent care center. These results showed that 20% were classified as ESI 2, “thus requiring immediate interventions and increased unit resources,” and 73% as ESI 3, “meaning longer lengths of stay and increased resource consumption.”
The hospital will continue to monitor the ESI data and compare it to the oncologic case mix seen in the urgent care center. “Based on the high levels of acuity and resource consumption needed to care for these patients, this data would provide the foundation to increase staffing and space to improve care delivery and flow for the oncology patient,” she concluded.