Department of Emergency Medicine and Institute for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Acad Emerg Med. 2012 Jan;19(1):106-9. doi: 10.1111/j.1553-2712.2011.01240.x. Epub 2011 Dec 23.
Patient acuity triage systems can play an important role in supporting patient safety and emergency department (ED) operations. In 2003, the boards of the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) approved a joint statement calling for hospitals to adopt a reliable, valid, five-level triage scale such as the Emergency Severity Index (ESI). Still, there appears to be considerable variation in use of triage acuity systems in the United States, with many hospitals using three- and four-level systems that have not been validated. The purpose of this effort was to measure the use of various triage acuity systems in U.S. hospitals.
The authors conducted a cross-sectional analysis of secondary data. Data were obtained from the 2009 American Hospital Association (AHA) Annual Survey--an intensive questionnaire mailed to all U.S. general medical and surgical hospitals. In 2009, a question was added to the survey about hospitals' use of triage systems in EDs. Descriptive statistics were used to explore various triage acuity systems used by different types of hospitals.
Of the 4,897 hospitals surveyed, 82% responded, and 62% (3,024 hospitals) provided information on their ED triage system. The 2009 data revealed that the most commonly used triage system types were the five-level ESI (56.9% of responding hospitals) and three-level triage systems (25.2%). More than 70% of large hospitals and teaching hospitals use the ESI, and the unvalidated three-level systems were more common in small hospitals, public hospitals, nonteaching hospitals, and hospitals in the Midwest. The majority (72.1%) of all ED patient visits to hospitals in our sample were assessed using ESI; only 13.1% of visits were assessed using a three-level system.
Among our sample of more than 3,000 hospitals, the ESI was the most commonly used triage system, and more patients were triaged using the ESI than any other triage acuity system. Still, there is an opportunity to further promote the adoption of validated, reliable triage systems.
患者病情分诊系统在保障患者安全和急诊部门（ED）运作方面发挥着重要作用。2003 年，美国急诊医师学院（ACEP）和急诊护士协会（ENA）的董事会批准了一项联合声明，呼吁医院采用可靠、有效的五级分诊量表，如紧急严重程度指数（ESI）。然而，美国在使用分诊严重程度系统方面似乎存在相当大的差异，许多医院使用未经验证的三级和四级系统。这项工作的目的是衡量美国医院使用各种分诊严重程度系统的情况。
作者对二次数据进行了横断面分析。数据来自于 2009 年美国医院协会（AHA）年度调查，这是一项向所有美国普通内科和外科医院邮寄的密集问卷。2009 年，调查中增加了一个关于医院在 ED 使用分诊系统的问题。采用描述性统计方法探讨了不同类型医院使用的各种分诊严重程度系统。
在接受调查的 4897 家医院中，有 82%的医院做出了回应，其中 62%（3024 家医院）提供了有关其 ED 分诊系统的信息。2009 年的数据显示，最常用的分诊系统类型是五级 ESI（56.9%的回应医院）和三级分诊系统（25.2%）。大多数大型医院和教学医院使用 ESI，而未经验证的三级系统在小型医院、公立医院、非教学医院和中西部医院中更为常见。我们样本中超过 70%的所有 ED 患者就诊都使用 ESI 进行评估；只有 13.1%的就诊使用三级系统进行评估。
在我们的 3000 多家医院样本中，ESI 是最常用的分诊系统，使用 ESI 进行分诊的患者比使用任何其他分诊严重程度系统的患者都多。尽管如此，仍有机会进一步推广采用经过验证、可靠的分诊系统。
