When a patient arrives in an emergency department, it is essential to quickly determine the severity of their condition in order to ensure effective management. This is where the emergency triage score comes in, an essential tool in the management of medical emergencies.

Based on validated triage scales, this score allows patients to be classified according to their degree of urgency, ensuring that those requiring immediate attention are prioritized. In ophthalmology, for example, emergencies can range from sudden blindness due to retinal artery occlusion (RAO) to acute infections such as endophthalmitis or corneal abscesses.

Each situation requires a rapid and precise assessment to measure the risk and determine the level of medical prioritization. Triage scores, ranging from 1 to 5, are key tools to ensure optimal patient management, both for healthcare professionals and for patients wishing to understand this essential process.

Understand the emergency triage score.

Origin and importance of the emergency triage score

The emergency triage score was created in response to the problem of flow management in emergency departments, which often have to deal with a significant number of patients that sometimes exceeds their immediate capacity for care. This triage system stems from a necessity: to prioritize care according to the severity of patients' medical conditions, ensuring that critical cases are treated as a priority.

The essential value of the triage score lies in its ability to optimize care times and processes, enabling the implementation of diagnostic and therapeutic approaches that comply with current medical standards. This organization directly contributes to improved efficiency of emergency services, while reducing waiting times for patients requiring rapid intervention.

Scoring system overview

The scoring system used in emergency triage is based on priority scales, such as the Canadian Triage and Acuity Scale (CTAS) or the Emergency Severity Index (ESI). These tools allow patients to be classified according to their level of urgency at the emergency reception, generally under the responsibility of nurses and physicians. Each assigned level corresponds to specific codes for accessing care and maximum waiting times before treatment.

For example, a score of 1 reflects a life-threatening emergency requiring immediate intervention, while a score of 5 indicates a stable and non-urgent clinical condition. These triage scales include vital parameters such as heart rate, systolic blood pressure, or respiratory rate, possibly associated with tools such as the Glasgow Coma Scale to further refine the prioritization.

These scoring systems are also subject to regular validations and updates, ensuring that they remain adapted to current medical practices. This rigor ensures that each patient benefits from personalized care adapted to the severity of their condition with optimal effectiveness.

Scale 1: High criticality

Definition and characteristics of cases classified as level 1

Cases classified under scale 1, also designated as "resuscitation" or "life-threatening emergency", correspond to situations where the patient's life is immediately threatened. These patients require immediate and continuous medical care to avoid serious or even fatal consequences.

Criteria for this level of triage include conditions such as cardiac arrest, respiratory arrest, shock, severe hypotension, or any other condition that presents an imminent risk of deterioration.

Examples of situations and immediate management

Situations requiring classification under level 1 are particularly critical and necessitate rapid medical intervention. Here are some examples of these situations:

• Cardiac or respiratory arrest: These cases require immediate cardiopulmonary resuscitation (CPR), often accompanied by defibrillation if necessary.
• State of shock: This may include hypovolemic shock, cardiogenic shock, or septic shock, where blood pressure is severely compromised and where measures to restore tissue perfusion must be taken immediately.
• Major trauma: Patients with severe trauma, such as head, chest, or abdominal injuries, who exhibit abnormal vital signs are also classified under this scale.
• Uncontrolled massive hemorrhage: Significant blood loss that threatens the patient's life and requires immediate surgical intervention or hemorrhage control measures.

In all these cases, immediate medical management is required, with continuous medical assessment and interventions to ensure patient stability and prevent any deterioration in their condition.

Scale 2: High urgency

Definition and specificities of urgent but non-critical cases

Cases classified under scale 2, also known as "very urgent", concern situations where the life or physical integrity of a patient's limb is threatened, but less immediately than for cases classified under scale 1. These situations require rapid medical intervention – although it is not imperative to act immediately. Conditions characteristic of this triage level include altered states of consciousness, serious but not imminently life-threatening cardiovascular problems, significant trauma, or severe infections warranting prompt management.

Rapid management: procedures and examples

The management of patients classified under scale 2 must combine efficiency and speed to avoid possible deterioration of their condition. Specific examples of situations requiring this level of triage include:

• Altered state of consciousness: Patients with infectious, inflammatory, ischemic, traumatic, toxicological, or metabolic issues affecting their sensorium—whether confusion, seizures, or coma—must be treated promptly to prevent potentially serious complications.
• Cardiovascular problems: Conditions such as severe hypertension, excessive tachycardia, or visceral-type chest pain require immediate medical evaluation, ideally within a maximum of 15 minutes.
• Trauma: Serious injuries such as open fractures, penetrating lesions or head trauma accompanied by signs of respiratory distress call for prompt, accelerated treatment.
• Severe infections: Certain infectious pathologies – whether septic shock, severe acute respiratory infections, or cellulitis associated with signs of sepsis – require urgent intervention to prevent their progression.

In each of these situations, regular patient reassessment remains essential. Close monitoring is generally ensured, with a new assessment performed every 15 minutes by medical staff to detect any worsening of the patient's condition and adapt care accordingly.

Scale 3: Moderate urgency

Characteristics of level 3 situations

Patients classified under level 3, also designated as 'urgent,' present with situations requiring evaluation and medical management within a relatively short timeframe. However, these cases do not present the same level of criticality as those of scales 1 and 2. The symptoms or conditions in question may potentially compromise the prognosis or the function of a limb, but without immediate urgency.

These situations include moderate alterations in the state of consciousness, significant breathing problems without acute distress, visceral-type chest pain without signs of serious complications, infections of intermediate intensity, or trauma without imbalance of vital signs.

Approach to care and prioritization

Level 3 patients require medical management within 30 minutes of their arrival. Here are the essential elements to guarantee their compliant and effective management:

• Initial assessment: The triage nurse performs a rapid analysis of the main symptoms and vital signs. This includes measuring respiratory rate, systolic blood pressure, and an assessment using the Glasgow Coma Scale to gauge the level of consciousness.
• Regular re-evaluation: In order to monitor any changes in their condition, patients should be re-evaluated every 30 minutes by a nurse. This observation helps to prevent any deterioration and adjust the care plan as needed.
• Medical interventions: Care includes, among other things, the administration of treatments to relieve symptoms, the performance of additional examinations such as X-rays or blood tests, and, if necessary, seeking specialized medical advice. Continuous nursing care plays a key role in patient monitoring.
• Prioritization: Although level 3 patients present with moderate severity, their care remains a priority over patients classified as levels 4 and 5. Prioritization is based on factors such as the severity of symptoms, medical history, and certain risk factors such as age and sex.

In conclusion, managing cases classified under scale 3 requires a proactive and rigorous approach. By ensuring that medical needs are met within the allotted time, quality care is provided, which can prevent progression to a more critical condition.

Scale 4: Low urgency

Description of level 4 and the cases concerned

Patients classified under the 'level 4' scale, corresponding to low urgency, present with medical conditions that require neither immediate intervention nor urgent management. These cases are generally stable, and the patients do not show any abnormal vital signs. Typical diagnoses include situations such as non-acute abdominal pain, minor skin infections, mild allergies, superficial injuries, or moderate respiratory symptoms.

Although less critical, these patients should be examined by a physician to confirm their stability and to assess the need for any additional examinations or adapted treatments. Vital signs remain normal, and the absence of major risk factors does not warrant urgent care.

Patient management and impact on emergency department flow

Managing patients classified under level 4 plays a key role in the organization and proper functioning of emergency services. Here are some key points:

• Assessment and reassessment: These patients should be regularly reassessed by a nurse, ideally every 60 minutes, to ensure their condition does not deteriorate. This approach ensures continuous monitoring and allows for rapid adaptation of their care if necessary.
• Prioritization of care: Although not classified as urgent, these patients should be treated within a reasonable timeframe to prevent any potential deterioration of their general condition. Prioritization is based on the assessment of individual risk factors and associated symptoms.
• Resource optimization: These patients, who do not require complex interventions, allow medical resources to be valued for critical cases. Effective management at this level helps reduce waiting times and improve overall quality of care for all emergencies.
• Impact on Emergency Department flow: Appropriate management of level 4 patients promotes a steady flow within the departments. By directing them to dedicated waiting areas and reassessing them regularly, medical teams can ensure that priority emergencies are treated in a timely manner, while providing less urgent patients with a reassuring environment and appropriate care.

In conclusion, effective management of scale 4 patients helps maintain optimal organization and an essential balance in emergency departments. Each patient thus benefits from adapted care while ensuring a harmonious flow for the entire emergency system.

Scale 5: Non-urgent

Situations classified as non-emergency

Cases classified under scale 5, or "non-urgent", correspond to situations where the patient does not present with an acute or urgent medical condition. These patients may have health problems that are either acute but non-urgent, or related to chronic problems that do not require immediate medical intervention.

Some typical examples of non-emergency situations include mild abdominal pain, minor skin infections without signs of sepsis, mild allergies, superficial wounds, or well-controlled chronic health problems. These patients generally have no abnormal vital signs, and do not require intensive care or complex medical interventions. Their treatment can therefore be carried out within a reasonable timeframe, without compromising their health.

Patient Management and Advice

The management of patients classified under scale 5, although less urgent, remains important to preserve their well-being and avoid any potential deterioration of their condition. Here are the main elements related to their management:

• Assessment and reassessment: Although these patients do not require immediate intervention, reassessment by a nurse every 120 minutes is essential to ensure their condition remains stable. This continuous monitoring allows for necessary adjustments to the care plan if the situation evolves.
• Advice and education: Non-urgent patients can benefit from information about their health condition, including home care, medication management, lifestyle modifications, and prevention methods to avoid complications.
• Access to care: It is imperative to ensure that these patients are treated within a reasonable time frame, generally within 120 minutes. Even if they do not require immediate intervention, their medical evaluation within this time frame guarantees their safety.
• Resource optimization: By directing these patients to appropriate waiting areas and implementing periodic re-evaluations, medical teams can better allocate resources to more critical cases while ensuring that non-urgent patients receive the necessary support.

In summary, effective management of patients classified under scale 5 helps maintain an optimal balance in the organization of emergency services. This not only makes it possible to reserve intensive care for absolute emergencies, but also to guarantee that each patient benefits from care adapted to their condition, within timeframes that respect medical priorities.

Impact of the emergency triage score on hospital management

Optimization of resources and management of waiting lists

The triage score plays an important role in optimizing hospital resources and managing waiting lists. By classifying patients according to their level of urgency, medical teams can allocate resources more effectively.

The most critical patients, classified under scales 1 and 2, are treated as a priority, which maximizes the chances of success of medical interventions and reduces the risk of serious complications. This triage approach helps to manage waiting lists more efficiently.

By regularly reassessing waiting patients, nurses and physicians can adjust the priority level and ensure that the most urgent patients are treated without delay. This reduces overall waiting times and improves the credibility of the triage system, thus preventing premature departures of patients that could have adverse consequences on their health.

Improvement of the quality of care and patient satisfaction

The triage score also contributes to improving the quality of care and patient satisfaction. By ensuring that patients are assessed and treated according to their level of urgency, medical teams can provide more appropriate and faster care.

• Reduction of morbi-mortality: Triage allows for rapid identification of the most seriously ill patients and provision of necessary care, which can reduce morbi-mortality. Studies have shown that patients classified with a high triage score and treated quickly have better outcomes in terms of survival and recovery.
• Patient satisfaction: The triage process, although sometimes perceived as impersonal, can improve patient satisfaction by providing clear information on waiting times and the reasons for their prioritization. This reduces anxiety and frustrations related to expectations, and patients appreciate the transparency and effective communication of medical teams.
• Efficiency of care: Triage allows patients to be directed to the appropriate care pathways, thereby reducing the care burden for less urgent cases. This allows medical teams to focus on the patients who need it most, thereby improving the overall efficiency of care.

In summary, the emergency triage score is an essential tool for optimizing hospital management, reducing waiting lines, and improving the quality and satisfaction of care.

Conclusion

In summary, the emergency triage score is an essential tool in the management of emergency departments. This triage system allows to effectively prioritize patients according to their level of urgency, using triage scales such as the Canadian Triage and Acuity Scale (CTAS). Thanks to a rapid and precise evaluation, these tools directly contribute to optimizing the timeframes and pathways of care.

The nurse's role in this system is fundamental. They ensure that the most critical patients receive the necessary care as a priority, while ensuring an intelligent allocation of available resources. Understanding and applying these triage principles is of major importance to improving the overall quality of care. This not only reduces waiting times, but also increases patient satisfaction. By adopting these practices in emergency departments, medical teams can not only save lives, but also prevent serious complications.

In conclusion, it is essential to implement and maintain rigorous triage protocols, coordinated effectively. These protocols remain essential to ensure optimal care for patients in emergency situations, while strengthening the safety and outcomes of medical interventions.

FAQ

What are the main triage levels used in emergency departments, and what are the criteria for each level?

In emergency departments, particularly in France, a structured triage system with six levels is used. This system is based on the FRENCH (French emergency nurse classification in hospital) classification:

• Triage 1: Corresponds to patients requiring immediate medical and nursing care, as their vital prognosis is threatened (deep coma, myocardial infarction, early stroke).
• Triage 2: Includes patients whose vital or functional prognosis is likely to be compromised in the short term (active bleeding, serious trauma, severe asthma attack, altered vital parameters).
• Triage 3: Concerns potentially serious or complex situations but without obvious signs of severity (e.g., acute abdominal pain, chest pain, or unusual headache). Here, we distinguish between level 3a, for fragile patients requiring care in less than one hour, and level 3b.
• Triage 4: Intended for patients whose reason for consultation does not compromise their vital or functional prognosis, but who require an isolated hospital procedure (X-ray, suture, etc.).
• Triage 5: Includes patients whose state of health does not require any immediate hospital resources, without the need for urgent additional examinations.

These levels are defined after analyzing the severity of symptoms, vital parameters, and the complexity of care.

How do triage nurses determine the degree of urgency of a patient, and what are the key factors they take into account?

At triage, nurses assess the urgency of a patient using the Canadian Triage and Acuity Scale (CTAS), comprising five priority levels. This assessment generally lasts less than five minutes. Several parameters are taken into account: reason for consultation, medical history, vital signs, and guided questions. These elements make it possible to determine the level of risk and clinical priority associated with the patient's condition. This clinical judgment remains paramount and may evolve if the patient's condition changes over time.

What is the difference between the external and internal care circuits after triage, and when is each circuit used?

The distinction between the external and internal circuit depends on the patient's state of health and the resources required:

• Internal circuit: Concerns patients triaged as urgent or very urgent (example: CTAS levels 1, 2, or 3). These patients receive immediate or rapid care, generally in a hospital setting, with intensive or specialized care.
• External circuit: Addressed to patients assessed as low priority (example: CTAS levels 4 or 5). These individuals may be referred to outpatient consultations or community health services since they do not require rapid intervention in the hospital.

These pathways are established using triage tools, such as ETG or the Emergency Severity Index (ESI) score, to optimize the quality and speed of care.

What factors influence waiting time after triage in an emergency department, and how are these factors managed?

Emergency department waiting times after triage depend on several major variables:

• Affluence and patronage: The simultaneous arrival of many patients increases the waiting time.
• Priority of cases: Patients in immediate or serious danger are treated before others.
• Staff availability: A smaller staff increases the time to provide care.
• Bed availability: Delays may occur in finding available hospital beds.
• Complexity of care: The execution of biological tests, X-rays or other procedures prolongs the duration of interventions.

These constraints are managed through the rigorous implementation of tools such as ETG in order to prioritize responses to patient needs while adapting the medical strategy to these factors.