Evidence from a comparative study demonstrates the need for ESI algorithm education and practice. The study noted that despite high confidence levels in the ESI process nurses showed low accuracy in ESI assignment. The study demonstrated a need for continued education on the ESI process, including return demonstration. The study highlights that this is a critical skill for ED nurses, and it is not included in nursing school curricula, and is therefore a specialized skill that needs cultivated in professional practice. See citation below. It is the expectation of all triage nurses in training to attend an ESI training class. It is a consistent need throughout the emergency service line as triage nurses are tasked with evaluating more patients than ever. New RNs report that they struggle with assigning acuities and that the class helps put the pieces together before they are in the triage role.

Triage Preparation Course

1. Introduction 15 minutes

1. Why do we triage?
2. Significance of triage
3. Define Roles/Processes
   1. Pivot
      1. HH- assigns acuity, allergies, chief complaint
      2. CG & WS- often does full triage
   2. Triage
   3. Pit Process

2. Emergency Severity Index (ESI) 45 minutes
   1. What it is
   2. Why we use it
      1. 1. Standard
         2. Properly allocating resources
         3.  
   3. Algorithm
   4. Describe Decision Points
3. Consent to Treatment 15 minutes
   1. Who is allowed to consent for treatment
   2. Special circumstances
      1. 1. Emancipated minor
         2. POA

IV.         Screening Questions

               A. Required part of Triage

               B. Triage nurse’s responsibility

4. Protocols/Standards of Care 35 minutes
   1. Protocols
      1. What are they?
         1. Sets of orders approved by physicians
         2. Must be done in their entirety, cannot pick and choose certain tests.
      2. Overview of available protocols
      3. Discussion of common protocols
      4. Radiology protocols (what studies can be ordered)
   2. Standards of Care
      1. EKG for CP patients in 10 minutes
      2. Waiting room rechecks q2 hours
      3. Vital signs q2 hours
   3. Delegation in Triage
5. Special Populations 30 minutes
   1. Pregnant patients
      1. >16 wks with bleeding to L&D
      2. >20 wks with abdominal pain to L&D
   2. Behavioral Health Patients
      1. Contact Security
      2. 1st wanding prior to triage
   3. Communicable Diseases
      1. Flu, TB, meningitis, etc.
      2. Mask as soon as flu-like symptoms are reported
      3. Document under isolation in triage navigator
   4. SAFE Cases
      1. Contacting safe program
      2. Treating medical conditions first
      3. Domestic Violence/Child abuse
6. Alerts 15 minutes
   1. Stroke Alert
   2. STEMI
   3. Trauma
7. Patient Departures from ED 10 minutes

1. Against Medical Advice
2. Left Without Treatment/Left Without Being Seen
3. Elopement
4. Discharge (from PIT/Triage Area)

VIII.  EMTALA Consideration 10 minutes

              A.  What is EMTALA and how does it relate to Triage

              B.  All patients must have medical screening exam

              C.  Patients who do not follow code of conduct

                        i. Often escorted out by security

                        ii.  Still need to have Medical Screening Exam

8. Downtime 15 minutes
   1. Review paper triage form
   2. Practice in real time (include in binder, or have extra?)
9. Case Studies 20 minutes
   1. Consent Scenario
   2. ESI Scenarios (5?)
   3. LWOT scenario
10. Policies not gone over in classroom, have in binder for resource

1. #112-9- Roles and Responsibility of the ED Triage Nurse
2. #113-3- Consent for ED treatment
3. #111-14- ED management of pt with hx or c/o sexual abuse or assault
4. #112-8- Emergency Department Triage System
5. #ECR-4- Refusal of Treatment and Leaving Against Medical Advice.
6. #112.10- X-rays initiated by Registered Nursing Personnel at Triage

11. Discussion/Questions 30 minutes