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The very concept of triaging patients in the emergency department invokes a broad range of opinions. Many consider triage a complete waste, asserting that triage can be viewed as simply a way to determine who can wait the longest to be seen. Others believe that triage is a vital aspect of the traditional emergency department encounter and is valuable from many perspectives, the most important of which is that

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Triage ensures that the most severe acuity patients with the highest need have the correct resources applied as quickly as possible.

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Proponents of traditional triage assert that it is a singular place to collect all of the critical data required by physicians and nurses to have an efficient patient encounter and by regulatory agencies to ensure the visit is in compliance with quality standards. Opponents of triage argue that it does not add value from the patient's perspective and that all of the steps preceding the physician encounter actually delay the value that the patient seeks. They would add that all of the data elements collected in triage can be collected at other points during the patient encounter. Thus, according to this argument, the only real value in triage is to

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  • Recognize patients requiring immediate intervention
  • Prevent delays in care that result in poor outcomes
  • Stream all patients through efficient pathways to meet their needs
  • Expedite the movement of patients from the door to the physician or midlevel provider1

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Shrinking numbers of emergency departments, growing volumes, and overcrowding caused by delays in moving admitted patients to inpatient beds have all resulted in bottlenecks in ED patient flow.2 These bottlenecks are the most frequently cited causes of “sentinel events” in EDs and have driven the need for rapid yet reliable classification of acuities followed by efficient movement of patients through ED systems.3

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As the number of EDs has decreased, the average ED patient volume has correspondingly increased to meet the growing demand of patients. As ED volumes and acuities increase, the ED environments become much more complex and classic economies of scale are rarely recognized. In fact, many EDs become less efficient per treatment bay and provider as annual volume and volume per bed increase. As a result, many EDs develop refined treatment pathways for certain subgroups of patients using a process known as segmentation. This process creates customized pathways for certain patient segments and employs an experienced eye at the front door to “stream” or direct the patient through a particular pathway based on the fewest number of inputs necessary.

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The enactment of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 has had a considerable impact on the role of registration and has prevented delays in evaluation and treatment due to financial screening. The recent push toward getting the patients in front of physicians in a more timely manner has also ...

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