Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Irish Children's Triage System (ICTS)

In 2016, the National Emergency Medicine Programme (EMP) launched the Irish Children's Triage System (ICTS) at RCSI.

The development of the ICTS was prompted by the triage experiences of front-line Emergency Department (ED) nurses and doctors caring for children and advanced by the Emergency Nursing Interest Group and Working Group of the EMP as a safety and quality improvement initiative. It is used for the prioritisation and assessment of paediatric patients presenting to Emergency Departments. The system supports safer, more effective, timely ED care and reflects the importance of child and family experiences of emergency care.

It also makes a significant contribution to the suite of clinical tools developed by the EMP to drive improvement in the safety, quality and value of emergency care in Ireland. ICTS was piloted and audited in six hospitals across Ireland and will become the national standard for all children who present to Emergency Departments in Ireland.

Background on ICTS

The triage of children in EDs is an established standard of care in international and national practice. However, the triage of children can be difficult compared to adults and additional triage parameters are recommended in ICTS to reflect age-related physiological differences, children's presenting signs and symptoms, significant paediatric co-morbidities and common paediatric emergency medicine diagnoses.

The outcomes of the ICTS are:

  • An evidenced-based approach to the triage of children that supports clinical decision making with regard to the symptoms and clinical management of the patient. The adoption of this tool will ensure that children receive the same standard and quality of care regardless of where in the country they present for treatment. 
  • A specific triage tool to clinically assess children attending EDs that facilitates the prompt recognition of acuity for ill or injured children. This tailored-tool includes clinical elements such as, physiological vital signs, pain management, temperature and other special guidelines specific to the needs of children.

 

Background on the Emergency Medicine Programme

The National EMP is one of a number of clinical programmes under the Clinical Strategy and Programmes Directorate (CSPD) of the HSE. The aim of the EMP is to improve the safety and quality of patient care in EDs and to reduce waiting times for patients.

The programme is led by a multidisciplinary working group that includes consultants in emergency medicine, emergency nurses, representatives of pre-hospital care and the therapy professions.

The objectives of the National Clinical Programme in Emergency Medicine are to:

  • Define a National Emergency Care System comprising networks of EDs fully integrated with pre-hospital and hospital-based services, ensuring a standardised approach to the delivery of high quality emergency care.
  • Increase patient access to consultant-provided care through increased Cconsultant numbers and expanded hours of consultant presence in EDs.
  • Develop roles for nurses including staff nurses, clinical nurse specialists and advanced nurse practitioners, for therapy professionals, medical social workers and other members of the multidisciplinary team.
  • Implement new clinical governance structures and processes to ensure clear authority, accountability and responsibility across the emergency care system.
  • Integrate implementation of the EMP with all relevant programmes, particularly critical care, paediatrics, older people, acute medicine, surgery and radiology.