Establishing Research Priorities for the Emergency Severity Index Using a Modified Delphi Approach

Abstract

IntroductionThe accuracy of an initial ED triage decision has been reported to drive the clinical trajectory for ED patients, and, therefore, this assessment is critical to patient safety. The Emergency Severity Index—a 5-point score assigned by a triage nurse and based on disease acuity, patient potential for decompensation, and anticipated resource use—is used both in the United States and internationally. In the US, the Emergency Severity Index is used by up to 94% of the academic medical center emergency departments. In 2020, the Emergency Nurses Association acquired the intellectual property rights to the Emergency Severity Index and is responsible for its maintenance and improvement. ObjectiveThe purpose of this study was to establish a research agenda for the improvement of individual and institutional understanding and use of the Emergency Severity Index. MethodsModified Delphi process was used with 3 rounds of data collection. ResultsRound 1 yielded 112 issues, which were collapsed into 18 potential research questions in 4 general categories: education and training (6 questions), workplace environment (3 questions), emergency care services (7 questions), and special populations (2 questions). These questions were used in round 2 to establish importance. Round 3 yielded a rank ordering of both categories and research questions. DiscussionThe research priorities as set through the use of this modified Delphi process align well with current gaps in the literature. Research in these areas should be encouraged to improve the understanding of educational, environmental, and process challenges to emergency nurses’ triage decisions and accuracy of Emergency Severity Index assignments.