Who’s Next In Line? The Emergency Center Triage System

Triage system in Emergency CenterUnlike typical waiting lines, where a “first-come, first-serve” process is standard, the order with which emergency center (EC) patients are seen and treated is determined by a triage system designed to rapidly identify and prioritize patients based on the severity of their illness or injury and their need for emergent therapy. By using key information, such as patient age, signs and symptoms, past medical and surgical history, physical examination, and vital signs (which may include heart rate, blood pressure, breathing rate, oxygen level and pain score), the triage system helps to determine the order and priority of emergency treatment.

Many emergency centers, including Texas Children’s Hospital, use a standardized, 5-level triage system. Following a focused, triage assessment and examination by a highly skilled triage nurse, the patient is assigned a triage level, with the highest triage level reserved for those patients who need emergent and life-saving treatment. Overall, the EC patient’s wait time is not only determined by his/her own triage level, but also the triage level of all of the other patients in the emergency center! It’s important to remember that triage is a dynamic process! Although a patient may be assigned a lower triage level on arrival, if his/her symptoms or vital signs worsen over the course of the EC visit, the patient will be reassessed and reassigned a new triage level.

Let’s go through a triage example! Imagine 3 patients arriving in the EC at the same time.

The first patient is Jasmine, a 3-month-old baby with a fever of 102.2°F for 2 days. The second patient is Carlos, a healthy 7-year-old with fever of 104°F for 4 days. The third patient is Jennifer, a 12-year-old who recently received chemotherapy for leukemia, but today has a fever of 101°F. After checking each patient’s vital signs, all of the patient’s vital signs are normal, except for Jennifer’s, the third patient. Her heart rate is very high and her blood pressure is very low.

So, based on this information, which patient should be seen first, second and third? Using the triage system as a guide, the order would be:

  • 1st – Jennifer
  • 2nd – Jasmine
  • 3rd – Carlos

Although all of the patients are ill with fever, Jennifer’s past medical history (leukemia, chemotherapy) and abnormal vital signs prioritize her as needing immediate, lifesaving medical treatment. Even though Carlos has been sicker longer and has a higher fever, Jasmine’s young age (and lack of 4 and 6 month vaccinations) plays an important role in determining her triage level, thereby placing her 2nd in line. Therefore, Carlos will be seen last, not because he isn’t sick, but, relative to Jennifer and Jasmine, he can safely wait the longest for medical evaluation and treatment.

In the Texas Children’s Medical Center and West Campus Emergency Centers, your child’s health and comfort is very important to us! If a waiting period is expected, our trained triage and protocol nurses may utilize pre-established protocols or standardized orders to help improve your child’s symptoms (i.e., Tylenol for fever) or facilitate the evaluation of your child (i.e., X-rays for a broken bone). Additionally, they will oftentimes reassess your child’s vital signs, signs/symptoms, and response to therapy to ensure that your child’s illness or injury is not worsening. However, if you ever feel that your child is getting sicker (i.e., increased work of breathing, severe/unbearable pain, decreased responsiveness or difficult to awaken, seizure-like activity, etc.), please inform an EC staff member immediately!


About Dr. Katherine Leaming-Van Zandt, Pediatric Emergency Medicine Specialist

I am a pediatric emergency medicine physician at Texas Children's Hospital Main and West Campuses, and am board certified in both pediatrics and pediatric emergency medicine.

My academic interests include: patient and family-centered care, physician/patient communication and patient satisfaction.

Posted in Emergency Center, Intensive Care, Parenting, West Campus

4 Responses to Who’s Next In Line? The Emergency Center Triage System

  1. Sandra S. says:

    I experienced the TCH ER for the first time ever a few weeks ago when my 18 MO daughter had an abnormal heart rate and rapid pulse. The ER techs did an excellent job running the appropriate tests and ensuring that we were comfortable with the follow up plan upon our release. We were very pleased with the experience and if necessary will not hesitate to visit the TCH ER again! :)

    • Amina says:

      We have been to TC ER West campus atleast 5 times in last 1 1/2 years, we were always taken care of right away. They are excellent at what they do. Love the ER staff as well as clinics there.

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