The Use of and Satisfaction with the Emergency Severity Index

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The Emergency Severity Index (ESI) is a 5-level emergency department triage algorithm designed to facilitate the sorting and streaming of patients. The purpose of this study was to assess the use of the ESI in emergency departments, including satisfaction with the ESI, usefulness of the ESI compared with other triage algorithms, and lessons learned from implementation.


A self-administered questionnaire was sent to 935 people who requested the ESI training materials from the Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services and who volunteered to participate in a study about the ESI. The response rate for the survey was 42% (n = 392). Telephone interviews were conducted with an additional 19 ED professionals. Descriptive statistics and qualitative content analysis were used in the data analysis.


Three hundred twenty-two survey respondents (82%) reported that they use the ESI in their emergency department. Satisfaction with the ESI triage algorithm is high. ESI users indicated that the ESI is more accurate than other triage algorithms and that its strengths are simplicity of use and the ability to reduce the subjectivity of triage.


The majority of ED professionals who reported using the ESI were very satisfied with the tool. Users found that it was more accurate than other triage algorithms and reduced the subjectivity of the triage process. Both survey and interview findings indicated that few emergency departments have formally assessed the impact of the ESI on ED operations.

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