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Review
. 2025 May 6;13(9):1070.
doi: 10.3390/healthcare13091070.

Adult Triage in the Emergency Department: Introducing a Multi-Layer Triage System

Dimitrios Tsiftsis  1 , Andreas Tasioulis  1 , Dimitrios Bampalis  2
Affiliations
Review

Adult Triage in the Emergency Department: Introducing a Multi-Layer Triage System

Dimitrios Tsiftsis et al. Healthcare (Basel). .

Abstract

Emergency department (ED) triage is the cornerstone of ED operations. Many different triage systems have been proposed and implemented globally. To date, an ideal triage system has not yet been identified. As the burden on EDs rises, with overcrowding being recognized as a universal problem, ED triage needs to be restructured to address this reality. Extensive and critical literature research over the years has identified the strengths and weaknesses of current ED triage implementations. A novel multi-layer triage system was introduced and implemented in Greek Eds, combining the strengths of various triage and early warning systems and scores to minimize under-triage and the adverse downstream effects it creates on patient outcomes. Acknowledging that no triage system can be universally adapted in different settings, the structural concepts of this triage system address most of the triage problems currently reported in the literature.

Keywords: ESI; HEART; NEWS; early warning scores; emergency department; triage.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The multi-layer triage approach. Based on the Ben Aveling cheese model [6]. ESI, emergency severity index; NEWS 2, national early warning score 2.
Figure 2
Figure 2
NEWS 2 chart. (Royal College of Physicians. National early warning score (NEWS) 2: standardizing the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017).
Figure 3
Figure 3
NEWS 2 thresholds and triggers. (Royal College of Physicians. National early warning score (NEWS) 2: standardizing the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017).
Figure 4
Figure 4
The HEART score [34].
Figure 5
Figure 5
HEART score interpretation and stratification. (MACE = Major adverse cardiac events).
Figure 6
Figure 6
Rosier scored [37]. BM, blood glucose; BP, blood pressure (mm Hg); GCS, Glasgow coma scale; E = eye; M = motor; V = verbal component.
Figure 7
Figure 7
Scheme 1: the multilayer triage flow chart.
See this image and copyright information in PMC

References

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