TRIAGE IN THE HOSPITAL

The word "triage" is derived from the French verb "trier," to "sort" or "choose." Originally the process was used by the military to sort soldiers wounded in battle for the purpose of establishing treatment priorities. Injured soldiers were sorted by severity of their injuries ranging from those that were severely injured and deemed not salvageable, to those who needed immediate care, to those that could safely wait to be treated. The overall goal of sorting was to return as many soldiers to the battlefield as quickly as possible GENERAL PRINCIPLES Function of triage Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Triage aims to ensure that patients are treated in the order of their clinical urgency and that their treatment is appropriately timely. It also allows for allocation of the patient to the most appropriate assessment and treatment area, and contributes information that helps to describe the departmental casemix. Urgency refers to the need for time-critical intervention - it is not synonymous with severity. Patients triaged to lower acuity categories may be safe to wait longer for assessment and treatment but may still require hospital admission. All patients presenting to an Emergency Department should be triaged on arrival by a specifically trained and experienced registered nurse. The triage assessment and Triage Scale code allocated must be recorded. The triage nurse should ensure continuous reassessment of patients who remain waiting, and, if the clinical features change, re-triage the patient accordingly. The triage nurse may also initiate appropriate investigations or initial management according to organisational guidelines. The triage area must be immediately accessible and clearly sign-posted. Its size and design must allow for patient examination, privacy and visual access to the entrance and waiting areas, as well as for staff security. The triage area should be equipped with emergency equipment, facilities for standard precautions (handwashing facilities, gloves), security measures (duress alarms or ready access to security assistance), adequate communications devices (telephone and/or intercom etc) and facilities for recording triage information. That initial triage of patients occur within 10 minutes of arrival and Must include vital signs. If triage times extend beyond 15 minutes, an additional nurse Should be immediately called. Accurate triage is the key to the efficient operation of an emergency department Effective triage is based on the knowledge, skills and attitudes of the triage nurse Paediatric patients should have their vital signs taken every 30 minutes when indicated and other patients should have an hourly triage reassessment where indicated. Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Urgency refers to the need for time-critical intervention - it is not synonymous with severity. Patients triaged to lower acuity categories may be safe to wait longer for assessment and treatment but may still require hospital admission.

Goals of Triage 1. Rapidly identify patients with urgent,life-threatening conditions 2. Assess/determine severity and acuity of the presenting problem 3. To ensure that patients are treated in the order of their clinical urgency 4 To ensure that treatment is appropriately and timely. 5. To allocate the patient to the most appropriate assessment and treatment area 6..Re-evaluate patients awaiting treatment Advantages of Triage 1. Streamlines patient flow 2. Reduces risk of further injury/deterioration 3 Improves communication and public relations 4 Enhances teamwork 5. Identifies resource requirements 6 Establishes national benchmarks Triage Acuity Determinants 1. Chief complaint 2. Brief triage history 3. Injury or illness (signs & symptoms) 4. General appearance 5. Vital signs 6. Brief physical appraisal at triage Key points in Triage in the emergency department 1. The assessment/triage area must be immediately accessible and clearly sign-posted. Its design should allow for: patient examination means of communication between entrance and assessment area privacy 2. Strategies to protect staff will exist 3. The same standards for triage categorisation should apply to all Emergency Departments (ED) settings. It should be remembered however that a symptom reported by an adult may be less significant than the same symptom found in a child and may render a child's urgency greater. 4. Victims of trauma should be allocated a triage category according to their objective clinical urgency. As with other clinical situations, this will include consideration of high-risk history as well as brief physical assessment (general appearance +/- physiological observations). 5. Patients presenting with mental health or behavioural problems should be triaged according to their clinical and situational urgency, as with other ED patients. Where physical and behavioural problems coexist, the highest appropriate triage category should be applied based on the combined presentation. 6. The most urgent clinical feature identified determines the ATS category. 7. Once a high-risk feature is identified, a response equal to the urgency of that feature should be initiated.

Examples of Triage Acuity Systems 2 Levels Emergent Non-emergent 3 Levels Emergent Urgent Nonurgent 4 Levels Life-threatening Emergent Urgent Nonurgent 5 Levels Resuscitation Emergent Urgent Nonurgent Referred

Level 1 Resuscitative Level 2 Emergent Level 3 Urgent Level 4 Less urgent Level 5 Non-urgent Levell II:: Resusciittattiive Leve Resusc a ve Conditions that are threats to life or limb (or imminent risk of deterioration) requiring aggressive interventions. Requires immediate attention of Nurse and Doctor Levell III Emerrgentt Leve Eme gen Conditions that are a potential threat of life, limb or function, requiring rapid medical intervention or delegated acts. Requires immediate attention of nurse and 15mts for Doctors attention Levell IIII Urrgen t Leve U gen Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living. Upto 15mts for Nurse and upto 30 mts for Doctor Levell IIV:: Less Urrgentt Leve V Less U gen Conditions that related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within 1 2 hours) Upto 30mts for Nurse and upto 60 mts for Doctor Levell 5:: Non Urrgentt Leve 5 Non U gen Conditions that may be acute but non-urgent as well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other area of the hospital or health care system. Upto 60mts for Nurse and upto 120 mts for Doctor

TRIAGE SCALE CATEGORY ACUITY (Maximum waiting time) PERFORMANCE INDICATOR THRESHOLD Category I Immediate 100% Category- II 10 minutes 80% Category - III 30 minutes 75% Category- IV 60 minutes 70% Category- V 120 minutes 70%

Allocation of Triage Category PROCEDURE 1. On arrival assess the patient. Balance the need for speed against the need to be thorough. All patients presenting to an Emergency Department should be triaged on arrival by a specifically trained and experienced registered nurse. The triage assessment should generally take no more than two to five minutes Measure vital signs at triage if required to estimate urgency, and if time permits. The triage assessment is not necessarily intended to make a diagnosis, although this may sometimes be possible. 2. Determine the clinical urgency of the patient. Use a combination of the presenting problem, general appearance and possibly physiological observations to assess the patient's urgency. Notify doctor on call of patient's arrival and ATS category as required. Indicate urgency of doctor's attendance. 3. Allocate Triage Scale (I- V) : is a scale for rating clinical urgency so that patients are seen in a timely manner, commensurate with their clinical urgency. 4. Take any patient identified as ATS Category 1 or 2 into the appropriate assessment and treatment area immediately. A more complete nursing assessment should be done by the treatment nurse receiving the patient. 5. Meet any immediate care needs. Standing orders may apply 6. As appropriate, initiate appropriate investigations (e.g. x-rays) or initial management according to hospital protocol. Waiting time is reduced and patient satisfaction is increase where nursing staff follow protocols and order tests and or management. 7. Document details of the triage assessment on the record and Include at least the following details: Date and time of assessment Name of triage nurse Chief presenting problem(s) Limited, relevant history Relevant assessment findings MDC and BRIS code (if applic.) Initial triage category allocated Any diagnostic, first aid or treatment measures initiated. Use a trauma record form as appropriate 8. Ensure continuous reassessment of patients who remain waiting. Re-triage a patient ifhis/her condition changes while they are waiting for treatment

additional relevant informationbecomes available that impacts on the patient's urgency Both the initial triage and any subsequent categorisations should be recorded, and the reason for the re-triage documented.

TRIAGE IN THE EMERGENCY DEPARTMENT The Triage Scale: Descriptors for Categories The clinical descriptors listed in each category are based on available research data where possible, as well as expert consensus. However, the list is not intended to be exhaustive nor absolute and must be regarded as indicative only. Absolute physiological measurements should not be taken as the sole criterion for allocation to an ATS category. Senior clinicians should exercise their judgment and, where there is doubt, err on the side of caution.2 The most urgent clinical feature identified determines the triage scale category. Once a high-risk feature is identified, a response commensurate with the urgency of that feature should be initiated. Important time-critical treatment The potential for time-critical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinical outcome depends on treatment commencing within a few minutes of the patient's arrival in the ED

Category I RESUSCITATION Immediately Life-Threatening Condition- Immediate simultaneous assessment and treatment Conditions that are threats to life (or imminent risk of deterioration) and require immediate aggressive intervention. Clinical Descriptors (indicative only) Cardiac arrest Respiratory arrest Immediate risk to airway - impending arrest Respiratory rate <10/min Extreme respiratory distress BP< 80 (adult) or severely shocked child/infant Unresponsive or responds to pain only (GCS < 9) Ongoing/prolonged seizure IV overdose and unresponsive or hypoventilation Severe behavioural disorder with immediate threat of dangerous violence

Category II EMERGENT Immediately Life-Threatening Condition -Assessment and treatment within 10 minutes simultaneously) (often

The patient's condition is serious enough or deteriorating so rapidly that there is the potential of threat to life, or organ system failure, if not treated within ten minutes of arrival or Very severe pain Humane practice mandates the relief of very severe pain or distress within 10 minutes Important time-critical treatment The potential for time-critical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinical outcome depends on treatment commencing within a few minutes of the patient's arrival in the ED Clinical Descriptors Category 2 (indicative only) Airway risk - severe stridor or drooling with distress Severe respiratory distress Circulatory compromise - Clammy or mottled skin, poor perfusion - HR<50 or >150 (adult) - Hypotension with haemodynamic effects - Severe blood loss - Chest pain of likely cardiac nature Very severe pain - any cause BSL < 2 mmol/l Drowsy, decreased responsiveness any cause (GCS< 13) Acute hemiparesis/dysphasia Fever with signs of lethargy (any age) Acid or alkali splash to eye - requiring irrigation Major multi trauma (requiring rapid organised team response) Severe localised trauma - major fracture, amputation High-risk history: Significant sedative or other toxic ingestion Significant/dangerous envenomation Severe pain suggesting PE, AAA or ectopic pregnancy Behavioural/Psychiatric: - violent or aggressive - immediate threat to self or others - requires or has required restraint - severe agitation or aggression

Category III URGENT Potentially Life-Threatening-Assessment and treatment start within 30 mins The patient's condition may progress to life or limb threatening, or may lead to significant morbidity, if assessment and treatment are not commenced within thirty minutes of arrival . or Situational Urgency There is potential for adverse outcome if time-critical treatment is not commenced within thirty minutes or Humane practice mandates the relief of severe discomfort or distress within thirty minutes Clinical Descriptors (indicative only) Severe hypertension Moderately severe blood loss - any cause Moderate shortness of breath SAO2 90 - 95% BSL >16 mmol/l Seizure (now alert)

Any fever if immunosuppressed eg oncology patient, steroid Rx Persistent vomiting Dehydration Head injury with short LOC- now alert Moderately severe pain - any cause - requiring analgesia Chest pain likely non-cardiac and mod severity Abdominal pain without high risk features - mod severe or patient age >65 years Moderate limb injury - deformity, severe laceration, crush Limb - altered sensation, acutely absent pulse Trauma - high-risk history with no other high-risk features Stable neonate Child at risk Behavioural/Psychiatric: - very distressed, risk of self-harm - acutely psychotic or thought disordered - situational crisis, deliberate self harm - agitated / withdrawn / potentially aggressive

Category IV LESS URGENT Assessment and treatment start within 60 mins The patient's condition may progress to life or limb threatening, or may lead to significant morbidity, if assessment and treatment are not commenced within thirty minutes of arrival. or Situational Urgency The patient's condition may deteriorate, or adverse outcome may result, if assessment and treatment is not commenced within one hour of arrival in ED. Symptoms moderate or prolonged. or Humane practice mandates the relief of discomfort or distress within one hour Clinical Descriptors (indicative only) Mild haemorrhage Foreign body aspiration, no respiratory distress Chest injury without rib pain or respiratory distress Difficulty swallowing, no respiratory distress Minor head injury, no loss of consciousness Moderate pain, some risk features Vomiting or diarrhoea without dehydration Eye inflammation or foreign body - normal vision Minor limb trauma - sprained ankle, possible fracture, uncomplicated laceration requiring I investigation or intervention - Normal vital signs, low/moderate pain Tight cast, no neurovascular impairment Swollen "hot" joint Non-specific abdominal pain Behavioural/Psychiatric: - Semi-urgent mental health problem - Under observation and/or no immediate risk to self or others Category V - Less UrgentAssessment and treatment start within 120 mins The patient's condition is chronic or minor enough that symptoms or clinical outcome will not be significantly affected if assessment and treatment are delayed up to two hours from arrival or Clinico-administrative problems Results review, medical certificates, prescriptions only Clinical Descriptors (indicative only) Minimal pain with no high risk features Low-risk history and now asymptomatic Minor symptoms of existing stable illness Minor symptoms of low-risk conditions Minor wounds - small abrasions, minor lacerations (not requiring sutures) Scheduled revisit eg wound review, complex dressings Immunisation only

Behavioural/Psychiatric: - Known patient with chronic symptoms - Social crisis, clinically well patient

GENERAL PRINCIPLES 1.1 Function of triage Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Triage aims to ensure that patients are treated in the order of their clinical urgency and that their treatment is appropriately timely. It also allows for allocation of the patient to the most appropriate assessment and treatment area, and contributes information that helps to describe the departmental casemix. Urgency refers to the need for time-critical intervention - it is not synonymous with severity. Patients triaged to lower acuity categories may be safe to wait longer for assessment and treatment but may still require hospital admission. 1.2 The Triage Assessment The features used to assess urgency are generally a combination of the presenting problem and general appearance of the patient, possibly combined with physiological observations. The triage assessment should generally take no more than two to five minutes, obtaining sufficient information to determine the urgency and identify any immediate care needs. This does not preclude the initiation of investigations or referrals at this point. There must be a balance between speed and thoroughness. The triage assessment is not necessarily intended to make a diagnosis, although this may sometimes be possible. Vital signs should only be measured at triage if required to estimate urgency, or if time permits. Any patient identified as ATS Category 1 or 2 should be taken immediately into the appropriate assessment and treatment area. A more complete nursing assessment should be done by the treatment nurse receiving the patient. In Australasia, triage is carried out by emergency nurses. As triage is so important to both the smooth running of an ED and the outcome of the patients, it should be carried out by staff who are both specifically trained and experienced. 1.3 Safety at Triage Triage is the first point of public contact with the ED. Patients with the whole spectrum of acute illness, injury, mental health problems and challenging behaviour may present there. Pain, anxiety and/or intoxication in patients or their relatives may provoke or magnify aggressive behaviour. These factors may create a risk of harm for the triage nurse and other reception staff. It is essential that all EDs plan for this potential risk by providing a safe but non-threatening physical environment, providing minimisation-ofaggression training to front-line staff, and having safe protocols and procedures for dealing with challenging behaviour. Where the safety of staff and/or other patients is under threat, staff and patient safety should take priority and an appropriate security response should take place prior to clinical assessment and treatment. 1.4 Time to Treatment The time to treatment described for each ATS Category refers to the maximum time a patient in that category should wait for assessment and treatment. In the more urgent categories, assessment and treatment should occur simultaneously. Ideally, patients should be seen well within the recommended maximum times. Implicit in the descriptors of Categories 1 to 4 is the assumption that the clinical outcome may be affected by delays to assessment and treatment beyond the recommended times. Further research is still required to describe the precise relationship between the time to treatment and the

clinical outcome. The maximum waiting time for Category 5 represents a standard for service provision. The recommended performance thresholds represent realistic practice constraints in the clinical environment. However, there is no implied justification for prolonged delays for patients falling outside the required performance standards - all attempts should be made to minimise delays. 1.5 Practicality and Reproducibility The primary and most important role of triage is clinical. Therefore application of the ATS must occur in such a way that ensures patient safety and maximises flow through the emergency department. While it is desirable to attempt to maximise inter-rater reliability for reasons of inter-departmental comparisons and for casemix purposes, it must be recognised that no clinical coding system achieves perfect reproducibility. Acceptable levels of inter-rater agreement have been defined which allow for a realistic balance between clinical practicality and classification. 2. EXTENDED DEFINITIONS AND EXPLANATORY NOTES 2.1 Arrival Time The arrival time is the first recorded time of contact between the patient and Emergency Department staff. A recording accuracy to within the nearest minute is appropriate. There should be no delay between the physical arrival in the ED of a patient who is seeking care and their first contact with staff. 2.2 Time of Medical Assessment and Treatment Although important assessment and treatment may occur during the triage process, this time represents the start of the care for which the patient presented. A recording accuracy to within the nearest minute is appropriate: 2.2.1 Usually it is the time of first contact between the patient and the doctor initially responsible for their care. This is often recorded as "Time seen by doctor". 2.2.2 Where a patient in the ED has contact exclusively with nursing staff acting under clinical supervision of a doctor, it is the time of first nursing contact. This is often recorded as "Time seen by nurse". 2.2.3 Where a patient is treated according to a documented, problem specific clinical pathway, protocol, or guideline approved by the director of Emergency Medicine, it is the earliest time of contact between the patient and staff implementing this protocol. This is often recorded as the earlier of "Time seen by nurse" or "Time seen by doctor". 2.3 Waiting Time This is the difference between the time of arrival and the time of initial medical assessment and treatment. A recording accuracy to within the nearest minute is appropriate. 2.4 Performance Indicator Thresholds Where a patient has a waiting time less than or equal to the maximum waiting time defined by their ATS category, the ED is deemed to have achieved the performance indicator for that presentation. Achievement of indicators should be recorded and compared between large numbers of presentations.

2.4 Documentation Standards The documentation of the triage assessment should include at least the following essential details: o o o o o o o o o 2.5 Re-triage If a patient's condition changes while they are waiting for treatment, or if additional relevant information becomes available that impacts on the patient's urgency, the patient should be re-triaged. Both the initial triage and any subsequent categorisations should be recorded, and the reason for the re-triage documented. 3. SPECIFIC CONVENTIONS In order to maximise reproducibility of ATS allocation between departments, the following conventions have been defined: 3.1 Paediatrics The same standards for triage categorisation should apply to all ED settings where children are seen - whether purely Paediatric or mixed departments. All five triage categories should be used in all settings. This does not preclude children being seen well within the recommended waiting time for the ATS Category if departmental policy and operational conditions provide for this. However, for the sake of consistency and comparability, children should still be triaged according to objective clinical urgency. Individual departmental policies such as "fast-tracking" of specific patient populations should be separated from the objective allocation of a triage category. 3.2 Trauma All victims of trauma should be allocated a triage category according to their objective clinical urgency. As with other clinical situations, this will include consideration of high-risk history as well as brief physical assessment (general appearance +/- physiological observations). Although individual departments may have policies that provide for immediate team responses to patients meeting certain criteria, these patients should still be allocated an objective triage category according to their clinical presentation. Again, departmental "fast-tracking" policies or systems should occur separately to the objective allocation of a triage category. 3.3 Behavioural Disturbance Patients presenting with mental health or behavioural problems should be triaged according to their clinical and situational urgency, as with other ED patients. Where physical and behavioural problems co-exist, the highest appropriate triage category should be applied based on the combined presentation. While some acutely-disturbed patients may require an immediate clinical response (perhaps combined with a security response) to ensure their safety, it is recognised that some individuals entering an emergency department and posing an immediate threat to Date and time of assessment Name of triage officer Chief presenting problem(s) Limited, relevant history Relevant assessment findings Initial triage category allocated Retriage category with time and reason Assessment and Treatment area allocated Any diagnostic, first aid or treatment measures initiated

staff (eg brandishing a dangerous weapon) should not receive a clinical response until the safety of staff can be ensured. In this situation, staff should act so as to protect themselves and other ED patients, and obtain immediate intervention from security staff and/or the police service. Once the situation is stabilised, a clinical response can take place as (and if) required, and triage should then reflect clinical and situational urgency. 4. CLINICAL DESCRIPTORS 4.1 Source The listed clinical descriptors for each category are based on available research data where possible, as well as expert consensus. However, the list is not intended to be exhaustive nor absolute and must be regarded as indicative only. Absolute physiological measurements should not be taken as the sole criterion for allocation to an ATS category. Senior clinicians should exercise their judgement and, where there is doubt, err on the side of caution. 4.2 Most Urgent features Determine Category The most urgent clinical feature identified determines the ATS category. Once a high-risk feature is identified, a response commensurate with the urgency of that feature should be initiated.

AUSTRALASIAN TRIAGE SCALE: DESCRIPTORS FOR CATEGORIES

Response ATSCategory Category 1 Immediate simultaneous assessment treatment and Conditions that are threats to life (or imminent risk of deterioration) and require immediate aggressive intervention. Immediately Threatening LifeCardiac arrest Respiratory arrest Immediate risk impending arrest to airway Description of Category Clinical Descriptors (indicative only)

Respiratory rate <10/min Extreme respiratory distress BP< 80 (adult) or shocked child/infant severely

Unresponsive or responds to pain only (GCS < 9) Ongoing/prolonged seizure IV overdose and unresponsive or hypoventilation Severe behavioural disorder with immediate threat of dangerous violence

Category 2

Assessment and treatment within 10 minutes (assessment and treatment often simultaneous)

Imminently threatening

life-

Airway risk - severe stridor or drooling with distress Severe respiratory distress Circulatory compromise

The patient's condition is serious enough or deteriorating so rapidly that there is the potential of threat to life, or organ system failure, if not treated within ten minutes of arrival Or Important treatment time-critical

Clammy or mottled skin, poor perfusion HR<50 or >150 (adult) Hypotension with haemodynamic effects Severe blood loss

The potential for timecritical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinical outcome depends on treatment commencing within a few minutes of the patient's arrival in the ED or Very severe pain Humane practice mandates the relief of very severe pain or distress within 10 minutes

Chest pain of likely cardiac nature Very severe pain - any cause BSL < 2 mmol/l Drowsy, responsiveness (GCS< 13) decreased any cause

Acute hemiparesis/dysphasia Fever with signs of lethargy (any age) Acid or alkali splash to eye requiring irrigation Major multi trauma (requiring rapid organised team response) Severe localised trauma - major fracture, amputation High-risk history:

Significant sedative or other toxic ingestion Significant/dangerous envenomation Severe pain suggesting PE, AAA or ectopic pregnancy

Behavioural/Psychiatric:

violent or aggressive immediate threat to self or others requires or has required restraint severe agitation aggression or

Category 3

Assessment and treatment start within 30 mins

Potentially Threatening The patient's

Life-

Severe hypertension Moderately severe blood loss -

condition

may progress to life or limb threatening, or may lead to significant morbidity, if assessment and treatment are not commenced within thirty minutes of arrival or Situational Urgency There is potential for adverse outcome if timecritical treatment is not commenced within thirty minutes or Humane practice mandates the relief of severe discomfort or distress within thirty minutes

any cause Moderate shortness of breath SAO2 90 - 95% BSL >16 mmol/l Seizure (now alert) Any fever if immunosupressed eg oncology patient, steroid Rx Persistent vomiting Dehydration Head injury with short LOC- now alert Moderately severe pain - any cause - requiring analgesia Chest pain likely non-cardiac and mod severity Abdominal pain without high risk features - mod severe or patient age >65 years Moderate limb injury - deformity, severe laceration, crush Limb - altered sensation, acutely absent pulse Trauma - high-risk history with no other high-risk features Stable neonate Child at risk Behavioural/Psychiatric:

very distressed, risk of self-harm acutely psychotic or thought disordered situational crisis, deliberate self harm agitated / withdrawn

potentially aggressive Category 4 Assessment and treatment start within 60 mins Potentially serious The patient's condition may deteriorate, or adverse outcome may result, if assessment and treatment is not commenced within one hour of arrival in ED. Symptoms moderate or prolonged. Mild haemorrhage Foreign body aspiration, respiratory distress no

Chest injury without rib pain or respiratory distress Difficulty swallowing, no

or Situational Urgency There is potential for adverse outcome if timecritical treatment is not commenced within hour or Significant or Severity complexity

respiratory distress Minor head injury, no loss of consciousness Moderate features pain, some risk

Vomiting or diarrhoea without dehydration Eye inflammation or foreign body - normal vision Minor limb trauma - sprained ankle, possible fracture, uncomplicated laceration requiring investigation or intervention - Normal vital signs, low/moderate pain Tight cast, no impairement Swollen "hot" joint neurovascular

Likely to require complex work-up and consultation and/or inpatient management

or Humane practice mandates the relief of discomfort or distress within one hour

Non-specific abdominal pain Behavioural/Psychiatric:

Semi-urgent mental health problem Under observation and/or no immediate risk to self or others

Category 5

Assessment and treatment start within 120 minutes

Less Urgent The patient's condition is chronic or minor enough that symptoms or clinical outcome will not be significantly affected if assessment and treatment are delayed up to two hours from arrival or Clinico-administrative problems results review, medical certificates, prescriptions only

Minimal pain with no high risk features Low-risk history asymptomatic Minor symptoms stable illness Minor symptoms conditions and now

of

existing

of

low-risk

Minor wounds - small abrasions, minor lacerations (not requiring sutures) Scheduled revisit eg wound review, complex dressings Immunisation only Behavioural/Psychiatric:

Known patient with chronic symptoms Social crisis, clinically well patient