Emergency Medicine and Critical Care Triage

Triage is the French name for sorting. It is a common method used to discern who should be evacuated or treated first among a group of injured or severely ill patients. It has become a crucial function of the healthcare providers in charge of emergency services and overcrowded outpatient (clinics and emergency departments) or inpatient (trauma and intensive care units) environments. These areas are the most in need of an efficient and accurate system to identify the correct patients and the reason we focus on their challenges in this chapter. Triage is a very complex and challenging process, which requires knowledge, training, and experience. Unfortunately, having all the required skills does not guarantee an accurate triage. Guidelines have been published to improve the management of the triage process, but their implementation is in itself also riddled by innumerable challenges. Increased volumes of patients in the emergency departments cause severe patient flow inefficiencies and throughput; solutions proposed to improve them do not seem to work consistently. Despite the plethora of tools available for triage in the emergency departments and hospital wards, there is still a need for more accurate and reliable instruments to reduce under- and over-triage. Intensive care units are not less challenging. Day-to-day utilization and surge responses are influenced by the appropriateness of the strategies and policies in place of each unit and hospital. In this chapter, we examine some of these practitioners’ daily struggles and enumerate potential solutions.