2. During triage, does staff use criteria to determine severity levels? If so what criteria are used?

The Triage process is definitionally a tool to determine the order in which patients should be seen. Note that “the order in which patients should be seen” is the only legitimate function of Triage; it is never a question of “whether this patient should be seen’. Under EMTALA, all patients presenting to the ED must have a screening examination to determine whether an emergency medical condition exists.

Various classification systems are used to assess the level of severity of the presenting problem.

Severity of Medicaid cases in the ED
Nonelderly Medicaid patients are using emergency departments at higher rates than nonelderly privately insured patients, often for serious medical problems that require emergency care. Triage acuity was determined by staff on the patient’s arrival in the ED and is measured as the amount of time within which a patient needs medical attention. Numbers of visits in 2008 are reflected per 100 enrollees.

Triage acuity of visit Medicaid Private insurance
Emergent (0-14 minutes) 5.6 3.6
Urgent (15-60 minutes) 18.1 9.6
Semi-urgent (1-2 hours) 10.4 5.5
Nonurgent (2-24 hours) 4.5 1.6
No triage/unknown 7.2 3.7

Reference: “Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits are for Urgent or More Serious Symptoms,” Center for Studying Health System Change, Research Brief, No.23, July 2012

The Center for Disease Control’s publication “National Hospital Ambulatory Medical Care Survey: Fact Sheet, Emergency Department” includes data covering Triage status for all ED visits for 2009. The breakdown by category is as follows:

• Immediate: 2 percent
• Emergent: 10 percent
• Urgent: 42 percent
• Semiurgent: 35 percent
• Nonurgent: 8 percent
• No Triage: 3 percent

Thus, in this comprehensive survey, only 8 percent of all ED cases were characterized as “nonurgent” at the time of triage. The database was comprised of 21 percent of patients aged under 15 years old and another 16 percent aged 15 to 24 years. Medicaid or CHIP beneficiaries accounted for 29 percent of all patients in the survey. And while the report provides no definitions of the Triage categories, it is plain that the vast majority of ED presentations fell into a status that renders their categorization as potentially “unnecessary” as problematic at best, and at worst meaningless. Of further note is that the “Common reasons for visit” and “Common diagnoses” reported in the CDC database, while not limited to a pediatric population, show general concordance with those cited by Capital BC CHIP.