Emergency Severity Index, Version 4: Implementation …

1 Advancing Excellence in Health Care for Healthcare Research and QualityEmergency SeverityIndex, Version 4:ImplementationHandbookEmergency SeverityIndex, Version 4:ImplementationHandbookCopyright noticeThe Emergency Severity index Version 4 Triage Algorithm (the Algorithm ) is the intellectual property ofThe ESI Triage Research Team, LLC (the Author ). The Author has applied for copyright with the UnitedStates Copyright Office. The Algorithm is the sole and exclusive property of the Author, and the Agencyfor Healthcare Research and Quality has a license to use and disseminate the two works derived from thisalgorithm: the training two-DVD set ( Emergency Severity index Version 4: Everything You Need toKnow ) and the Implementation handbook ( Emergency Severity index Version 4: ImplementationHandbook ).

2 The Author hereby assures physicians and nurses that use of the Algorithm as explained inthese two works by health care professionals or physicians and nurses in their practices is permitted. Eachprofessional user of these two works is granted a royalty-free, non-exclusive, non-transferable license to usethe Algorithm in accordance with the guidance in these two Algorithm may not be changed in any way by any user. The algorithm and the contents of the DVDset and Implementation handbook may be incorporated into additional training materials developed by auser, on the condition that no fee is charged by the user for the Algorithm, the contents of these twoworks, or the additional training Algorithm has been rigorously tested and found to be both reliable and valid, as described in theresearch references included in these two works.

3 However, the Author and the Agency for HealthcareResearch and Quality require that the Implementation and use of the Algorithm be conducted andcompleted in accordance with the contents of these two works using the professional judgement ofauthorized physicians or nurses and staff directed and supervised by them. Each health care professionalwho decides to use this algorithm for Emergency triage purposes does so on the basis of that health careprovider's professional judgment with respect to the particular pateint that the provider is caring for.

4 TheAuthor and the Agency for Healthcare Research and Quality disclaim any and all liability for adverseconsequences or for damages that may arise out of or be related to the professional use of the Algorithmby others, including, but not limited to, indirect, special, incidental, exemplary, or consequential damages,as further set forth Author and the Agency for Healthcare Research and Quality have made a good faith effort to take allreasonable measures to make these two works accurate, up-to-date, and free of material errors in accordwith clinical standards accepted at the time of publication.

5 Users of these two works are encouraged touse the contents for improvement of the delivery of Emergency health care. Any practice described inthese two works should be applied by health care practitioners in accordance with professional judgmentand standards of care used in regard to the unique circumstances that may apply in each situation theyencounter. The Author and the Agency for Healthcare Research and Quality cannot be responsible for anyadverse consequences arising from the independent application by individual professionals of thematerials in these two works to particular circumstances encountered in their To Obtain Additional Copies of the DVDs and HandbookAdditional copies of the Emergency Severity index , Version 4: Everything You Need To KnowDVD set(publication no.)

6 05-0046-DVD) and spiral-bound Implementation Handbook(publication no. 05-0046-2),covering all the details of ESI, can be obtained by contacting the AHRQ Publications Clearinghouse at 1-800-358-9295 or by e-mail to You may request up to 3 free copies of both the DVDset and the Implementation Handbook. You can also view, download, and print a PDF Version of the manualonline at To Obtain Additional InformationFor additional information on the Emergency Severity index , Version 4, please e-mail your substantivequestions to Severity index , Version 4.

7 Implementation Handbooku u uNicki Gilboy, RN, MS, CENN urse Educator, Emergency DepartmentBrigham and Women's HospitalBoston, MAPaula Tanabe, PhD, RN Research Assistant Professor Northwestern University Department of Emergency Medicine and the Institute for Health Care Studies Chicago, ILDebbie A. Travers, PhD, RN, CENR esearch Assistant Professor University of North CarolinaChapel Hill, NCAlexander M. Rosenau, DODepartmental Associate Vice ChairProgram Director of the Emergency Medicine ResidencyDepartment of Emergency MedicineThe Lehigh Valley Hospital and Health NetworkAllentown, PADavid R.

8 Eitel, MD, MBAD irector, Health Services DesignCore Faculty, Emergency Medicine ResidencyDepartment of Emergency MedicineThe York HospitalWellSpan Health SystemYork, PAu u uThis handbook is dedicated to our leader,collaborator, and friend,Dr. Richard WuerzAt the time of his death Dr. Wuerz was an Attending PhysicianAssociate Research DirectorDepartment of Emergency MedicineBrigham and Women's HospitalBoston, MAandAssistant Professor of Medicine ( Emergency Medicine)Harvard Medical SchoolBoston, MAiiSuggested Citation:Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR.

9 Emergency SeverityIndex, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2. Rockville, MD: Agencyfor Healthcare Research and Quality. May from the DirectorThe Agency for Healthcare Research and Quality is pleased to bring you the Emergency SeverityIndex, Version 4: Implementation manual covers all details of the EmergencySeverity index (ESI) a five-level Emergency department triage algorithm that providesclinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (leasturgent) on the basis of acuity and resource needs.

10 After Emergency physicians Richard Wuerz and David Eitel developed the ESI in 1998 andpilot testing yielded favorable results, the ESI Triage Group was formed. Further work on theinitial development of ESI was carried out under an AHRQ grant. The ESI Triage Group, whichconsisted of medical clinicians, managers, educators, and researchers, further refined thealgorithm to what it is today. In keeping with our mission to improve the quality, safety, efficiency, and effectiveness ofhealth care for all Americans, one of AHRQ's areas of emphasis is training.