Emergency Triage

Manchester Triage Group

Kevin Mackway-Jones, Janet Marsden, Jill Windle, Kevin Mackway-Jones, Janet Marsden, Jill Windle

• Publisher: BMJ Books
• Year: 2013
• ISBN:
  9781118299050
• Edition: 3
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

The Manchester Triage System (MTS) is the most widely used triage system in the UK, Europe and Australia, with tens of millions of patients being processed through hospital emergency departments. It is also used in hospitals throughout Brazil.

Emergency Triage is the core text for the MTS, which utilises a risk averse system of prioritisation for patients in all unscheduled care settings. As such, it is an essential text for all emergency department staff using the MTS, in particular triage nurses. The book is both a training tool and a reference for daily use in the Emergency Department and prehospital settings.

This edition features revised protocols that reflect new approaches to prioritisation, with accompanying revised flowcharts - the core part of the book.

Table of Contents

Presentation flow charts index

1: Introduction

2: The decision-making process and triage

3: The triage method

4: Pain assessment as part of the triage process

5: Patient management, triage and the triage nurse

6: Auditing the triage process

7: Telephone triage

8: Beyond prioritisation to other applications This Edition was updated in 2023 to Version 3.8.

CHAPTER 1
Introduction

Background

Triage is a system of clinical risk management employed in Emergency Departments worldwide to manage patient flow safely when clinical need exceeds capacity. Systems are intended to ensure care is defined according to patient need and in a timely manner. Early Emergency Department triage was intuitive, rather than methodological, and was therefore neither reproducible between practitioners nor auditable.

The Manchester Triage Group was first set up in November 1994 with the aim of establishing consensus among senior emergency nurses and emergency physicians about triage standards. It soon became apparent that the Group’s aims could be set out under five headings.

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• Development of the common nomenclature
• Development of common definitions
• Development of a robust triage methodology
• Development of a training package
• Development of an audit guide for triage

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Nomenclature and definitions

A review of the triage nomenclature and definitions that were in use at the time revealed considerable differences. A representative sample of these is summarised in Table 1.1, where the priority categories are shown on the left and the maximum respective times (in minutes) to first contact by a treating clinincan are listed in the right-hand columns.

Table 1.1

Hospital 1		Hospital 2		Hospital 3		Hospital 4
Red	0	A	0	Immediate	0	1	0
Amber	<15	B	<10	Urgent	5–10	2	<10
		C	<60	Semi-urgent	30–60
Green	<120	D	<120
Blue	<240	E	–	Delay acceptable	–	3	–
		FGHI

Despite this enormous variation, it was also apparent that there were a number of common themes running through the timings of these different triage systems, and these are highlighted in Table 1.2.

Table 1.2

Priority	Max. time (minutes)
1	0	0	0	0
2	<15	<10	5–10	<10
3		<60	30–60
4	120	<120
5	<240	–	–	–

Once the common themes of triage had been highlighted, it became possible to quickly agree on a new common nomenclature and definition system. Each of the new categories was given a number, a colour and a name and was defined in terms of ideal maximum time to first contact with the treating clinician. At meetings between representatives of Emergency Nursing and Emergency Medicine nationally, this work informed the derivation of the United Kingdom triage scale shown in Table 1.3.

Table 1.3

Number	Name	Colour	Max. time (minutes)
1	Immediate	Red	0
2	Very urgent	Orange	10
3	Urgent	Yellow	60
4	Standard	Green	120
5	Non-urgent	Blue	240

As practice has developed over the past 20 years, five-part triage scales have been established around the world. The target times themselves are locally set, being influenced by politics as much as by medicine, particularly at lower priorities, but the concept of varying clinical priority remains current.

Triage methodology

In general terms a triage method can try and provide the practitioner with the diagnosis, with the disposal or with a clinical priority. The Triage Group quickly decided that the triage methodology should be designed to allocate a clinical priority. This decision was based on three major tenets. First, the aim of the triage encounter in an Emergency Department is to a...