If you work in the hospital, surely you know what it is the triage system that is applied in it, but do you know the rest of the systems that exist? At the moment, there are five triage scales that are the most used worldwide and in all of them its scientific evidence has been recognized. These scales are:
ATS (created by the Australian College of Medicine).ACCOUNTS (introduced by the Canadian Association for Emergencies, CAEP)MTS (introduced by the Manchester Triage Group).ESI (developed by the ESI working group).SET (established as a standard for Spain by SEMES). All these scales have in common that They are made up of five levels of emergency prioritization and are based on care needs, symptom categories, degree of involvement of constants and reasons for consultation. In addition, all of them establish reevaluation of the patient that has exceeded the waiting time marked by the scale, assessing their health status again and establishing the corresponding priority level. Generally, these structured triage systems allow measure quality indicators such as the waiting time to be seen, the duration of the triage, the patients lost before being seen by the doctor and the waiting time to be assessed by the doctor.
ATS triage system
The first of the systems mentioned above is the ATS. This system had the Ipswich and NTS scale as predecessors, but new modifications were added such as the assessment of the physiological state of the patient, discriminators that influence their categorization and risk modifiers. So the level is set Assessing the general appearance of the patient as a whole and the clinical feature that has the most urgency. Therefore, the duration should be between 2 and 5 minutes. It’s based on five levels of prioritization:
Level 1: resuscitation, need for immediate attention.Level 2: emergencies, the prognosis depends to a great extent on the time it takes to be seen, with a maximum waiting time of 10 minutes.Level 3: urgent, it is potentially urgent, if it exceeds the time it can become a vital emergency, with a maximum waiting time of 30 minutes.Level 4: semi-urgent, there is no urgency at the moment, but if the time is exceeded, it can become an urgency, with a maximum waiting time of 60 minutes.level 5: non-urgent, less urgent or administrative procedures, with a maximum waiting time of 120 minutes. Generally, this triage system is performed by nursing, medicine, or bothbut provided they have received specific training.
CTAS triage system
This system was developed by Robert Beveridge and introduced by CAEP and the National Emergency Number Association (NENA). Establishes a maximum period of 10 minutes for the patient to be assessed after his arrival at the SU. In order for this to be possible, if there are patients waiting to be triaged, they will not be fully triaged, but rather they will be asked for enough information to assign a level. The levels are:
Level I: resuscitation, need for immediate medical action, such as cardiac arrest, major trauma, shock states, serious respiratory diseases…Level II: emergency, immediate medical intervention is necessary, such as in patients with altered mental status, severe trauma, abdominal pain, bleeding, dyspnea, asthma… The waiting time is 15 minutes.Level III: urgent, patients can evolve into a serious problem, either due to head trauma, suicidal ideas, severe pain… The waiting time is 30 minutes.Level IV: less urgent, patients who need intervention, but the evolution is not life-threatening, for example, patients with mid-abdominal pain, headache, vomiting… The waiting time is 60 minutes.Tier V: non-urgent, they are patients who do not need immediate attention, such as chronic patients or those who do not suffer deterioration. The waiting time is 120 minutes. This triage is performed by nursing and both subjective information is collected (provided by the patient or companion) as objective (observed and assessed by the nurse). In addition, both the treatment you usually take and the allergies you have are recorded.
MTS triage system
The MTS triage system is also classified in 5 levels and is performed by nursing. These levels are:
Level 1: Inmediate attention.Level 2: very urgent, with a waiting time of 10 minutes.Level 3: urgent, with a waiting time of 60 minutes.Level 4: normal, with a waiting time of 120 minutes.level 5: non-urgent, with a waiting time of 240 minutes.
ESI triage system
This system bases its classification by level in discriminators and use of resources. In addition, it does not mark waiting times, since the objective is treat all patients as soon as possibletherefore, to assign the level, the reason for the query is not taken into account.
ISE 1: life-threatening, intubated patients, apneic patients, pulseless patients.ISE 2: severe pain, life-threatening situation with a significant alteration in the level of consciousness, patients who need two or more diagnostic tests with changes in vital signs, patients who need therapeutic actions…ISE 3: patients who need two or more diagnostic examinations with normal constants or patients who need two or more therapeutic actions with preserved vital signs.ISE 4: patients with normal vital signs and need for a single diagnostic exploration or therapeutic action.ISE 5: patients who do not need diagnostic exploration or therapeutic action. The triage in yes it is done by nursing through a question algorithm: “Can the patient die?”: If the answer is yes, the patient belongs to level 1, if the answer is no, we would go on to the next question.“It can wait?”: If the answer is no, it would correspond to level two, if the answer is yes, the third question would be asked.“How many resources will you need?”. This question has three options:Many: “altered vital signs?”: If yes, it is considered level 2, if no, it is considered level 3.One: this answer would lead to level 4.None: the level is directly established. level 5
SET triage system
In the SET triage system, each level corresponds to a color and, in addition, it uses discriminators. It is performed by nursing without being exclusive. The levels are:
Level I: resuscitation, immediate life-threatening.Level II: emergency, with an immediate waiting time for nursing and 7 minutes for doctors.Level III: urgent, with a waiting time of 30 minutes.Level IV: less urgent, with a waiting time of 45 minutes.Tier V: non-urgent, with a time of 60 minutes.