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Level 2 and Level 3 Patients in Emergency Severity Index Triage System: Comparison of Characteristics and Resource Utilization

Garbez, Roxanne Oertel PhD, RN, ACNP; Carrieri-Kohlman, Virginia DNSc, RN, FAAN; Stotts, Nancy EdD, RN, FAAN; Chan, Garrett PhD, RN, APN-C, FAEN

doi: 10.1097/TME.0b013e318233d1c4
Cases of Note

There is a lack of studies examining distinctions between patients assigned to Level 2 (high risk) and Level 3 (lower risk) in the 5-level ESI triage system. Describing patients assigned to Level 2 and Level 3 may identify unique characteristics related to chief complaint, interventions, and resource needs. A convenience sample of triage nurses was recruited from 2 emergency department (ED) sites. If, at the completion of the patient–nurse triage interaction, the nurse assigned the patient to either Level 2 or Level 3, additional clinical data related to that patient were collected from the ED medical record. Eighteen triage nurses participated in the study with 334 nurse–patient triage interactions collected. Patients presenting with a chief complaint of nausea and vomiting or having a medical history of renal insufficiency/failure were significantly more often assigned to Level 2 than to Level 3 (p = 0.036 and p = 0.013, respectively). Patients assigned to Level 2 were more likely to utilize cardiac monitoring, electrocardiogram, medications, and specialty consultation than patients assigned to Level 3. It is critical that nurses in the triage setting be aware of possible patient factors and resource needs that could influence assignment to specific triage levels.

Department of Physiological Nursing, University of California, San Francisco.

Funding for this research was received from the Emergency Nurses Association and UCSF Century Club. No funding was received from the following organizations: National Institutes of Health; Wellcome Trust; and Howard Hughes Medical Institute.

Disclosure: The authors report no conflicts of interest.

Corresponding Author: Roxanne Oertel Garbez, PhD, RN, ACNP, School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143 (

© 2011 Lippincott Williams & Wilkins, Inc.