Emergency Nursing 5-Tier Triage Protocols

Most hospital emergency rooms currently use a 5-tier triage system. The 5-tier system is based on the following classifications: referred, non-urgent, urgent, emergent and resuscitation. The triage tier system has steadily progressed from a 2-level, to a 3-level, to most recently, a 4-level system. The 5-tier triage system has proven to be the one that prevents the most overlooked injuries or accidental ER fatalities. Although nurses have to be highly trained on how to properly assess patients, being able to do so quickly and accurately is saving lives.

Level 5

• Level 5 patients require the least of care in terms of emergency nursing protocol. Individuals classified as level 5 are patients who nurses have determined need little or no treatment. If patients do require treatment, it can typically be implemented by a verbal order or care plan, but require no contact or medication. According to Nurse.com, level 5 patients need none of the hospital's resources.

Level 4

• Level 4 patients require no more than one of the hospital's resources. These patients typically need minor treatment such as a medicine prescription or a lab test analysis and are described as "non urgent." Dimensions of Critical Care Nursing uses the following scenario as an example of a level 4 patient: A 30 year-old woman reports to the emergency room complaining of a twisted ankle. There is swelling, but her ankle is not deformed, and she is able to place her weight on the twisted ankle. Her treatment would consist of an x-ray, bandage and crutches.

Level 3

• Level 3 patients are described as "urgent" and require at least two of the hospital's resources, such as lab work, an electrocardiogram, sutures, IV fluids or a specialty consult. Between 30 to 40 percent of emergency room visits are classified as level 3, according to Nurses.com. Dimensions of Critical Care Nursing provides the following example of a level 3 patient: A young adult patient comes into the ER stating she is suffering from abdominal pain, abdominal tenderness and nausea. This patient will need IV fluids, a possible x-ray and blood work. Because more than two of the hospital's resources are used, this patient is classified as level 3.

Level 2

• Level 2 patients are classified as "emergent." While patients on level 3 through 5 are classified based on their use of the hospital's resources, patients classified as level 1 or 2 are determined based on their clarity of mind. Level 2 patients are unstable; their vital signs are compromised, and if left untreated, their situation will quickly deteriorate.

Level 1

• Level 1 patients need resuscitation and are the most serious in the 5-tier emergency nursing protocol. These patients are in life-threatening situations, and if not given emergency care immediately, may be at risk for death. According to Nurses.com, when determining whether a patient is level 1, you ask yourself the following question: Can this patient wait? If the answer is no, the patient is determined to be level 1.