Patients triaged based on condition, not age

(NEW YORK CITY) — When parents take their children to the hospital or emergency room, they expect their children to be seen by a doctor as soon as possible, but sometimes they may not been seen as quickly as many parents would like.

Hospitals and emergency rooms around the country are forced to make the decision of which patients should be admitted to the emergency room first, but when making a decision, where do children fit?

According to Dr. Marilyn Ho, supervisor of pediatric emergencies at Jacobi Medical Center in the Bronx, Jacobi treats patients with the most severe conditions first.

Jacobi Medical Center offers its pediatric emergency patients 13 examination rooms, two pediatric trauma bays and 13 patient asthma rooms.

Ho said hospitals in the United States use the Emergency Severity Index in order to determine which patients are in need of urgent care. The ESI was created in the late 1990s to create a general system for all hospitals to use.

 "The emergency severity index was created by the emergency nurse association so that all nurses can triage similarly throughout the nation," Ho said. "So, it is a standardized type of triage system."

She said the ESI levels rate the urgency of the patients condition and determines the priority in which patients needs to be seen by a doctor.

"Level one is considered urgent and is our resuscitation patients. Then, level two is our high-risk patients such as asthma, fever in babies, open fractures and diabetes," Ho said.  "A level three are urgent but not high risk. Levels three, four and five are not high risk levels."

Ho said the ESI levels are determined by the amount of resources needed to assist the patient. Therefore, if lab work, CAT scans, MRIs or other procedures are needed, then the patient is in need of a resource.

"So if a patient does not need a resource, then it is a level five. A class four is if you are going to need one resource. And if a patient needs to utilize two or more resources, it is a level three.

Dr. Kathy Chou, Assistant Director to Pediatric Emergency Medicine at Jacobi Medical Center, said the triage nurses usually decide which patients needs to have the most urgent care.


"It usually goes by the nature of complaints and what the patient looks like to the triage nurse," Chou said. "So, certainly something like difficulty breathing, sometimes seizures, or what we would call altered mental status or any significant trauma."

Chou said depending on the patient's condition, the time spent in the emergency room waiting room could be rather lengthy. She said the Pediatric Emergency Medicine unit sees more than 40,000 patients per year.


Chou said if patients arrive by ambulance but are not high-risk patients, they will still have to wait to be seen by a doctor. She said all patients who need to be seen first will have priority no matter the form of transportation.

"The wait time in the emergency rooms varies day by day. If it is very busy the wait time could be up to six or eight hours, but if it is not busy, patients could be seen quicker," Chou said. "Usually if it is a more urgent issue, then patients could be seen fairly quickly."


Dr. Maureen Gang, assistant professor in the NYU Medical Center Emergency Medicine department, said NYU Medical Center Emergency Medicine department ranks the patients through the ESI from most acute to least acute and children are not given priority if they are not high risk patients.

"Triage nurses assign levels, with preference given to patients based on need for care, not age," she said.

Gang said as Emergency Medicine doctors, everyone has to work as a team to be sure the patients are receiving the care needed. She said although preference is not given due to age, they NYU Medical Center does have doctors on hand to be available for pediatric patients.
"We have pediatric emergency medicine attendings who work in the ED [Emergency Department] from 8 a.m. to midnight daily," Gang said. "So, regarding pediatric patients — although we don't have a separate pediatric ED, when a pediatric patient arrives, they are seen based on pediatric ED patient acuity only. When there is no specific attending assigned to pediatrics, the pediatric patients are seen as triaged with the rest of the ED patient mix."