So in the ESI classes I have taken I was always told that a patients ESI level could not be downgraded. (more so to do with billing or something) That it could always be upgraded, but that it can't be downgraded. Has this changed or is this more regional??
As far as this case, I would have had to see the patient to decide if it was a 1 or 2.
As the other poster stated though, that "she is here all the time" thought process is how things get missed and outcomes end up poor.
We had a frequent flier patient once in our ED that was always in for either chest pain or psych issues. Her and her boyfriend. Legit one time I had to call (for the 2-3 day post discharge Studor calls) :| can her boyfriend was on the phone saying "Actually we are coming in right now, we will figure out why on the way there"
However, she came in as normal another time. Same complaints, we had no beds and a lobby full of people. She complained of chest pain. Charge nurse rolled her eyes and did her triage and put her in the hall and asked me if I would get her vitals when I had a chance and put them in. So I finish the IV I was placing for another nurse and go to hook Suzie up to the monitor in the hall. My cardiac monitor isn't registering and reading funny. I check the cords and adjust the stickers, still isn't picking things up and it flashes real quick 218 and then back to trying to obtain a signal. Patient is looking fine and behaving how she normally is. Rest of vitals are OK. Charge says she paged EKG tech and he was on his way. Told her I was having trouble registering a heart rate, she told me not to worry about it that she would enter it later and asked me to go start another IV. But I couldn't just ignore that. So I grab the EKG machine to do it myself and sure enough her HR is up in the 220's. I grab my stethoscope and listen and sure enough her heart is just a pounding away. I go to tell the doctor and he rolls his eyes thinking I must be an idiot I guess and tells me nothing is ever wrong with Suzie, she is a headcase. I look at the PA and was like "this ladies heart is about to beat out of her chest, I am more than willing to carry on about my day and just chart Notified MD and PA, MD states "patient is a headcase". if you want but I am pretty sure that isn't going to end well" I leave the room and go get the stuff to put an IV in her. We were slamming adenosine within a few minutes.