A key function in emergency medicine is to assign an acuity rating to new patients shortly after their arrival. This is done by the triage nurse on the basis of a cursory evaluation. If the nurse underassesses the patient, a long wait may ensue, thereby putting a critically ill patient at risk. The most common type of medical negligence in this scenario results in delayed treatment of an impending cardiac arrest. Several professional organizations have set standards regarding acuity assessment at triage to assist caregivers in avoiding unnecessary delays.
According to the Agency for Healthcare Quality and Research (AHQR), “[t]he purpose of triage in the emergency department (ED) is to prioritize incoming patients and to identify those who cannot wait to be seen. The triage nurse performs a brief, focused assessment and assigns the patient a triage acuity level, which is a proxy measure of how long an individual patient can safely wait for a medical screening examination and treatment. *** With more patients waiting longer in the waiting room, the accuracy of the triage acuity level is even more critical. Under-categorization (undertriage) leaves the patient at risk for deterioration while waiting. *** And rapid, accurate triage of the patient is important for successful ED operations.”
A medical malpractice claim may arise under Ohio law out of a delay in treatment in the setting of an emergency department visit. In response to concerns about delays occurring at triage, the Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) made joint recommendations for triage in emergency departments. A hospital’s failure to properly assess the patient’s acuity and risk of deterioration may fall below accepted standards for emergency medicine.
There are over 100 million visits to U.S. emergency departments each year according to the Centers for Disease Control and Prevention (CDC). Of those visits, less than 20% of patients were seen within 15 minutes, leaving the majority of patients waiting in the waiting room. In dire cases, early, accurate assessment is crucial to good care.
