As the number of emergency department visits increases, more hospitals use the five-level Emergency Severity Index to triage patients, according to the 2011 American Hospital Association Annual Survey. The severity index stratifies patients into five groups from 1 (most urgent) to 5 (least urgent) based on acuity and resource needs. Urban and teaching hospitals also are more likely to use the five-level ESI. Hospitals that receive 4,999 or fewer ED visits are more likely to use the three-level system, which classifies patients as emergent, urgent or nonurgent. Three-level system users tend to be smaller or rural organizations.

The American College of Emergency Physicians and the Emergency Nurses Association in 2003 announced their support for the adoption of a standardized five-level triage scale such as the ESI in emergency departments.

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