In order to simplify and make more uniform emergency department triage, the ESI acuity scale was developed. ESI has become very popular because it has been validated for interrater and inter-institution reliability and is even endorsed as a best practice by AHRQ ( the Agency for Healthcare Research and Quality). Dr. Wiler and others published an article in the Society of Academic Emergency Medicine in 2011 showed a moderate correlation between ESI triage scores and evaluation and management billing codes. the study concluded that there is a moderate nonlinear correlation between ESI levels and emergency department evaluation and management billing codes (99281-5 and 99291). She also notes that the older the patient has the more likely this correlation.
So what are the ramifications of this? Certainly this information could be helpful if ESI was determined to be correlating with measuring intensity of nursing care to determine level of staffing. It could also be potentially used to determine the intensity of physician care as well determine a real-time when a physician needs additional support. The non-direct correlation could also possibly demonstrate how diversion from emergency departments may not be a safe nor wise idea.
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