ESI triage.

While I haven't had a course, I consider myself reasonably knowledgable in ESI. Basically, I read all the information, and use the algorythm. Pretty simple. I have been in the box quite a bit lately.

The question is, should ESI triage differ from facility to facilty, or from provider to provider?

Looking at the literature, ESI level hinges on what the patient "needs". Unfortunately, I don't see the word "need" defined. We order stuff all the time that the patient doesn't need.

For example, pt is seen by pcp for abd pain, and the provider does no labs or xray/ct. does not prescribe any drugs. Pt is essentially unchanged later in the day, when they show up at the ER because 5 hours after their visit, they still don't feel well. From my perspective, this is a slam dunk category 5. The doc who knows this pt the best felt no resources were needed. What they "need" is to follow their own doctor's orders.

If there is an ER doc prone to doing lots of tests, this person will get ct and labs, maybe an IV. Level 3.

I find myself trying to guess what is likely to be ordered, and triage the patient accordingly. This helps the charge nurse figure out where to put the pt. While I would confidently stand by my nursing judgement that the above pt is a level 5, it screws things up when labs, ivf and ct are ordered.

This little guessing game gets especially tricky when there are 2 or more providers on with different practices. After a couple months, I know each provider, and usually know what they are likely to want. unfortunately, I have no way of knowing who is going to pick a particular pt up.

How do others deal with this?