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Understanding ENA’s Emergency Severity Index Handbook 5th Edition

December 12, 2023
December 12, 2023

This blog is taken from a recent HealthStream webinar entitled “Understanding the Emergency Nurse’s Association’s (ENA) Emergency Severity Index Handbook, 5th Edition.” The webinar was moderated by HealthStream’s Dan Pawlus and featured presenters:

  • Danielle McCallum, BSN, RN, CEN, Nursing Content Specialist, Emergency Nurses Association (ENA)
  • Andrew McKone, BSN, RN, Solution Executive, Clinical Programs, HealthStream


ENA’s Emergency Severity Index Handbook, 5th Edition

The Emergency Severity Index (ESI) triage system is used by more than 94% of U.S. hospitals. Despite this, research has found wide variance in triage accuracy rates. Recently the ENA released the fifth edition of its ESI Handbook and the ESI 2.0 online course which is now offered exclusively through ENA and HealthStream.


Why Does This Update Matter?

Triage is a multi-faceted and complex process. McCallum explained that it was clear that there was a lack of understanding about how to apply ESI which resulted in less-than-desirable triage accuracy. She went on to share that the tool’s algorithm is valid, reliable and has been well-researched across all age groups and in many different countries. ENA has updated the ESI education to help healthcare organizations feel more confident in the education and the ways in which they use it.  


Emergency Severity Index Handbook Fifth Edition – The Updates

McCallum shared some of the updates that were included in the fifth edition of the handbook. Some of the research supporting the evidence was updated. In fact, more than 75 of the references are either new or have been updated to demonstrate that the algorithm tool is and remains valid and reliable. The update provides additional clarity aimed at improving understanding and reducing misinterpretations. The handbook includes detailed explanations for each decision point and updated decision point presentations for more accurate identification of levels 1 and 2 patients. In addition, a new part of the handbook addresses the role of racism, bias, and stigmas – all of which can impact the accuracy of a triage decision.

McCallum shared that the update clarifies what nurses need to know as well as where they can find it in the handbook. Further, she recommended that a copy of the handbook be kept at the triage desk and at every nurse’s station for quick reference. 

The algorithm itself did not change, however, McCallum pointed out a wording change that would add clarity to the decision-making process and help nurses better understand when to re-evaluate triage decisions.

In addition, the handbook has updated vital signs by age group and has added additional age groups that include the standard vital sign ranges. Also included are the temperature ranges that support the sepsis criteria.

The updated handbook also includes a section on frequently asked questions.


ESI Course Updates

Next, presenters addressed the updates to HealthStream’s ESI 2.0 course. All of the updates from the handbook are included in the course which now incorporates a voiceover – a feature that many learners will find beneficial. Knowledge checks to evaluate retention are still included and have been updated to reflect the content of the new handbook. 

Additionally, there were some changes to the exams. The ESI Pediatric 2.0 now has pediatric-specific knowledge checks and exam questions and there are 25 new exam questions addressing the age-specific vital signs. A new exam structure now requires learners to answer 100% of Level 1 and Level 2 questions correctly.

HealthStream and ENA – Solutions for ESI Education

McKone shared the three ESI course components:  

  • Emergency Severity Index Adult and Pediatric Course – English Version
  • Emergency Severity Index Adult and Pediatric Course – Spanish Version
  • Emergency Severity Index Pediatric Course

The courses have a mobile first design with engaging and interactive modules designed to ensure that each patient receives high-quality, specialized emergency care. This proven approach can help your organization lower morbidity and mortality rates in the emergency department. In addition, the course has a pre-built curriculum that covers the updated handbook. CEUs are automatically tracked and recorded in the system and are easy to retrieve and report. McKone recommended that nurses review this course annually.

Finally, McKone urged customers to check to make sure that they are using the most recent ENA courseware and to check in with HealthStream if they are not using the 2.0 version of the courses.