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How emergency departments work: the triage system

Wednesday 12 April 2017

A cartoon of people waiting at a hospital, one person has bandages wrapped around them, one has crutches, another bandages, another is a doctor.
It's important to keep EDs for emergencies, so patients with severe illnesses or injuries can be treated.

Statistics show that not all Queenslanders are using hospital emergency departments correctly, with many people presenting each year with non-emergency health concerns. This can mean that emergency departments and their staff aren’t able operate to their full potential, and may put seriously ill patients at risk.

Below we’ve broken down the hospital triage system to help Queenslanders understand why it’s important to keep EDs for emergencies only, when to go to the ED and what might happen when they get there.

What is triage?

Triage is the name of the system that is used to sort when and where patients will be seen in an emergency department. Rather than operating on a ‘first come, first served’ system like you would expect at a restaurant, emergency departments use the triage system to sort patients into categories, so that they can attend to patients who need urgent help first.

The triage system exists because, while all patients at emergency departments may be experiencing serious illness or injury, those with life-threatening and severe conditions must be treated first.

EDs are very busy environments in which complex assessments, decisions and actions have to be made quickly. While no patient seeking assistance from an ED is refused care, people with less severe illnesses or injuries will have to wait longer for treatment than people with more urgent medical needs.

The Australasian Triage Scale

The Australasian Triage Scale defines five categories into which emergency department patients can be placed. Ratings 1 and 2 relate to the most serious of illnesses and injuries. Patients given a Rating 1 are those currently experiencing life-threatening illnesses or injuries that require immediate attention, including conditions like requiring resuscitation, haemorrhages, severe burns or anaphylaxis.

Rating 2 patients require very urgent attention, and may be seriously ill or injured. A patient might be classified as Rating 2 if they have had a stroke, have acute respiratory problems, have had an epileptic seizure, have a condition like meningitis or severe sepsis, or are experiencing acute psychosis.

Rating 3 relates to patients with serious illness or injury who are in a stable condition, while Rating 4 is for patients who are not in immediate danger or severe stress. Patients who have presented with a non-emergency health concern are classified as Rating 5.  

After being triaged, staff aim to treat patients given a Rating 1 immediately, Rating 2 within 10 minutes, Rating 3 within 30 minutes, Rating 4 within one hour and Rating 5 within two hours. These goals promote the treatment of patients within a suitable period of time, but may not always be able to be met if an ED is overcrowded with non-emergency patients.

Regardless of how they arrive at the ED, all patients are considered as part of the same triage system. Patients bought to emergency departments in ambulances don’t skip the triage queue, with only critically ill or injured patients seen immediately.

Hospital staff may take into account other factors as well as symptoms when triaging patients. For example, the age of the patient might be considered if it could impact how serious their health problem could become and how quickly they need to be treated. If a person has other known health conditions, like diabetes or pregnancy, this might also be taken into account when staff decide which rating they will fall into. The triage process is always ongoing, with a patient’s rating changed if their condition changes or deteriorates.

When should I go to an emergency department?

Emergency departments exist to treat patients with serious or life-threatening conditions.

If you, or someone you are caring for, become unwell or are injured, and you think that the condition might be an emergency, is life-threatening or it is causing severe discomfort, the emergency department is the right place to be. In the case of an emergency, call Triple Zero (000) and ask for an ambulance.

If not the ED, then where?

If you don’t think you’re in an emergency situation, but you or someone you are caring for still needs advice from a health practitioner, you can:

  • call 13 HEALTH (13 43 25 84) for advice from qualified health professionals. Staff can advise you if you need to call an ambulance for immediate help.
  • make an appointment with a General Practitioner (GP), or other relevant health professional, such as a dentist
  • or visit your pharmacy for help with symptoms of colds or flu, skin irritations, minor allergy symptoms, headaches, diarrhoea or constipation.

By not using emergency department resources for non-emergency situations, you will allow emergency staff to focus on people who are seriously unwell, and may find that you are treated more efficiently by the appropriate staff.

Last updated: 31 January 2018