Triage of Patients in NSW Emergency Departments

Summary

The purpose of this policy is to outline the key components of triage of patients

representing to Emergency Departments in NSW hospitals including the role, key

responsibilities and the processes that support efficient and safe triage.

Document type

Policy Directive

Document number

PD2013_047

Publication date

06 December 2013

Author branch

System Performance Support

Branch contact

(02) 9391 9538

Review date

30 January 2025

Policy manual

Patient Matters

File number

13/1433

Previous reference

N/A

Status

Review

Functional group

Clinical/Patient Services - Critical Care

Applies to

Local Health Districts, Board Governed Statutory Health Corporations, Chief

Executive Governed Statutory Health Corporations, Specialty Network Governed

Statutory Health Corporations, Public Health System Support Division, NSW

Ambulance Service, Ministry of Health, Private Hospitals and day Procedure Centres,

Public Health Units, Public Hospitals

Distributed to

Public Health System, Government Medical Officers, NSW Ambulance Service,

Ministry of Health, Public Health Units, Public Hospitals, Private Hospitals and Day

Procedure Centres

Audience

Administration;Emergency Departments

Policy Directive

Secretary, NSW Health

This Policy Directive may be varied, withdrawn or replaced at any time. Compliance with this directive is

mandatory for NSW Health and is a condition of subsidy for public health organisations.

POLICY STATEMENT

PD2013_047

Issue date: December-2013

Page 1 of 2

TRIAGE OF PATIENTS IN NSW EMERGENCY DEPARTMENTS

PURPOSE

The purpose of this policy is to outline the key components of triage of patients

presenting to Emergency Departments in NSW hospitals including the role, key

responsibilities and the processes that support efficient and safe triage.

This policy does not seek to outline the clinical components of this process; clinical

information related to triage is as indicated by the Australasian College for Emergency

Medicine’s (ACEM) policy

and guideline

on triage and the College of Emergency

Nursing Australasia (CENA) Position Statements on Triage.

3,4

This policy should be read in conjunction with NSW Health Policy PD2010_075

Emergency Department Patients Awaiting Care

MANDATORY REQUIREMENTS

• Triage is an essential function of an Emergency Department (ED). Triage (or an

alternative local ‘sorting’ process by a senior ED clinician) should be the first

interaction a patient has in the ED.

• ED and hospital processes must support the ability of triage to be carried out within

five minutes or less so as not to delay other patients awaiting triage. This includes

limiting the responsibilities and additional tasks required of the Triage Nurse, where

appropriate, so that focus can remain on timely triage of patients as they enter the ED

• The triage process encompasses a brief clinical assessment of the patient on arrival

to the ED to determine the priority for clinical care. Assignment of triage category

reflects the clinical urgency of the patient’s condition.

• The patient’s level of urgency is indicated using the Australasian Triage Scale (ATS)

and the Triage Nurse determines (in consultation with relevant ED and Ambulance

staff if required) the most appropriate place for the patient to commence or wait for

further treatment.

• It is recognised that triage is a dynamic process and may require that the patient be

re-triaged if their condition changes or deteriorates prior to being seen by a treating

clinician.

• The physical location and environment of triage must ensure the safety of staff and

patients and accommodate privacy for the assessment of patients.

• The process of Triage involves the application of high-level patient assessment skills

and knowledge to determine the patient’s degree of urgency to see a treating clinician

– it is for this reason that triage in NSW EDs should be carried out by Registered

ACEM Policy on the Australasian Triage Scale

http://www.acem.org.au/media/policies_and_guidelines/P06_Aust_Triage_Scale_-_Nov_2000.pdf

ACEM Guidelines on the implementation of the Australasian Triage Scale in Emergency Departments

http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation__ATS.pdf

CENA Position Statement: Triage Nurse http://cena.org.au/CENA/Documents/CENATriageNursePSJuly2009.pdf

CENA Position Statement: Triage and the Australasian Triage Scale

http://cena.org.au/CENA/Documents/2012_06_14_CENA_-_Position_Statement_Triage_FinalD2-1.pdf

POLICY STATEMENT

PD2013_047

Issue date: December-2013

Page 2 of 2

Nurses. It is not appropriate for clerical/administrative staff to undertake triage. In

Hospitals with ED role delineation level 1 & 2, there may be occasional circumstances

where an Enrolled Nurse is the first point of contact for a patient arriving in the ED.

Contingencies for this occurring are described in section 2.5 -Triage Education.

• Registered Nurses undertaking the triage role must demonstrate and maintain clinical

expertise in emergency nursing and have appropriate training in the triage role; the

requirements of which will be determined locally. Please see section 2.5 Triage

Education for further information on ‘expertise in emergency nursing.

IMPLEMENTATION

Local Health District and Specialty Health Networks are responsible for:

i. Assigning responsibility, personnel and resources to implement this policy

ii. Establishing mechanisms to ensure that the essential criteria are applied,

achieved and sustained as usual processes for triage; this should include

nomination of an executive sponsor

iii. Ensuring that any local policy reflects the requirements of this policy and is

written in consultation with responsible executive, Clinical Governance unit, ED

senior management, and senior clinical staff.

iv. Providing opportunity for Registered Nurses to complete local triage education

programs; ensure adequate supervision for Registered Nurses learning the

triage role and demonstrate local processes for the ongoing evaluation of

triage practice.

REVISION HISTORY

Version

Approved by

Amendment notes

December 2013

(PD2013_047)

Deputy Director

General, System

Purchasing and

Performance

New Policy

Replaces PD2008_009

ATTACHMENTS

1. Triage of Patients in NSW Emergency Departments: Procedures

Triage of Patients in NSW Emergency Departments

PROCEDURES

Issue date: December-2013

PD2013_047

Triage of Patients in NSW Emergency Departments

PROCEDURES

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Contents page

CONTENTS

1 BACKGROUND .................................................................................................................... 1

1.1 About this document ...................................................................................................... 1

1.2 Key definitions ............................................................................................................... 1

1.3 Legal and legislative framework .................................................................................... 3

2 COMPONENTS OF THE TRIAGE PROCESS ...................................................................... 4

2.1 The Purpose and role of Triage ..................................................................................... 4

2.2 Use of the Australasian Triage Scale............................................................................. 5

2.3 Re-triage of patients with deteriorating conditions ......................................................... 5

2.4 Triage location and safety requirements ........................................................................ 6

2.5 Triage education............................................................................................................ 6

2.6 Triage of Ambulance patients ........................................................................................ 8

2.7 Telephone advice .......................................................................................................... 9

2.8 Mass Casualty Disaster and Triage ............................................................................... 9

LIST OF RELATED DOCUMENTS........................................................................................... 10

Triage of Patients in NSW Emergency Departments

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1 BACKGROUND

1.1 About this document

Triage is an essential function of an Emergency Department (ED) and must be the first

interaction a patient has in the ED. This Procedure Document supports and further

explains the mandatory requirements of the Triage in NSW Emergency Departments

Policy through the following components:

• The purpose and role of Triage

• Use of the Australasian Triage Scale

• Re-triage of patients with deteriorating conditions

• Triage location and safety requirements

• Triage education

• Triage of Ambulance patients

• Telephone advice

• Mass Casualty Disaster and Triage.

1.2 Key definitions

For the purpose of the Policy Statement and this Procedures Document, the following

definitions apply:

Acuity:

Acuity is a synonym for urgency, and they can be used interchangeably. An acuity-based

description should answer the question: “This patient should wait for assessment and

treatment by a treating clinician no longer than…."

Australasian Triage Scale (ATS):

The Australasian Triage Scale (ATS) is a 5-point scale that is designed for use in hospital-

based emergency services throughout Australia and New Zealand. It is used to help sort

patients by clinical urgency.

Competency:

Competency refers to the consistent application of knowledge and skill to the standard of

performance required in the workplace. It is also the ability to consistently perform work

activities; applying skills and knowledge; to agreed standards over a range of contexts and

conditions.

Complexity:

Complexity relates to the difficulty of the presenting problem and the resources involved in

finding a solution to the problem. A low ATS category with a highly complex problem may

consume more resources and workload than a high urgency but low complexity

presentation.

http://www.hwa.gov.au/sites/uploads/national-competency-report-final-20120410.pdf.

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Emergency Triage Education Kit (ETEK):

The Emergency Triage Education Kit (ETEK) is a teaching resource that aims to provide a

consistent approach to the educational preparation of Australian emergency clinicians for

the triage role. In particular the ETEK has been designed to promote the correct use of the

ATS. The ETEK can be accessed via:

http://www.health.gov.au/internet/main/publishing.nsf/Content/casemix-ED-

Triage+Review+Fact+Sheet+Documents

Re-triage:

The process of re-triage involves an assessment of the waiting patient who has not been

assessed by a clinician responsible for care within the time frame allocated by the initial

triage category. The purpose of re-triage is to identify and escalate the care of a patient

whose condition is deteriorating, reassign an appropriate triage category and prioritise

clinical resources to manage the patient.

Streaming:

Streaming is a predetermined method of allocating patients to a particular treatment cohort

during the triage process based on specific criteria. Such criteria may include urgency or

complexity, age or presenting problem. Streaming may include allocation to a specific area

within the ED, a specific set of resources (eg. medical and nursing teams) or to a patient

service external to the ED (eg. specialty clinic). The practice of streaming patient

presentations from the point of triage into appropriate care areas is shown to result in

improvements in waiting times and ED length of stay.

Transfer of Care:

Transfer of Care in this policy refers to the NSW Health key performance indicator of the

percentage of patients arriving by ambulance whose care is transferred from paramedics

to ED staff within 30 minutes of arrival. Transfer of Care is defined as the transfer of

accountability and responsibility for a patient from an ambulance paramedic to a hospital

clinician.

Triage:

Triage is the process of assessment of a patient on arrival to the ED to determine the

priority for medical care based on the clinical urgency of the patient’s presenting condition.

triage enables prioritisation of limited resources to obtain the maximum clinical utility for all

patients presenting to the ED. The triage nurse applies an Australasian Triage Scale

category in response to the question: “This patient should wait for assessment and

treatment by a treating clinician no longer than…."

Triage of Patients in NSW Emergency Departments

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1.3 Legal and legislative framework

Duty of Care

By engaging with a patient as they present to the ED, the Triage Nurse enters into a health

professional–patient relationship. The Triage Nurse shares the responsibility of the

hospital to ensure that patients who present to the ED are offered an appropriate

assessment of their urgency of treatment requirements.

All nurses should have an understanding of basic legal principles, which include consent,

the elements of negligence, definition and sources of the standards of care, and how

policies and guidelines can influence practice to maximise patient safety. There is an

expectation that the Nurse performing the role of triage will have adequate experience,

training and supervision to perform the role. The employing institution also has a

responsibility to ensure that triage staff are adequately prepared to perform the role.

Patients who ‘Did Not Wait’ for treatment following Triage

Patients may choose to leave the hospital without being seen by the treating clinician in

the ED; if the patient is competent, the Triage Nurse cannot prevent them from leaving.

However, the Triage Nurse has a responsibility to advise the patient of the consequences

of such a decision, and appropriate documentation recording this event should be

completed (see ‘Documentation’ section below). Issues must be escalated to the

appropriate senior ED clinician in charge of the department as required.

Patients who have a cognitive impairment (e.g. from drug use, alcohol use, a head injury,

mental illness, delirium or patients at risk of suicide or with self-harm ideation) are at risk

from adverse events in such situations. The Triage Nurse must therefore consider their

duty of care in such cases. The Triage Nurse must be aware of and fulfil his or her

responsibilities with these patients and abide by any local policies or protocols. For the

purposes of triage, a rapid re-triage and/or escalation to senior ED staff may be indicated.

Documentation

Medical records are a method of communication for health care team members and are a

contemporaneous record of events. They must be accurate, clear and succinct. It is also

expected that the records will be easily accessible and able to be understood

Minimum information that is required to be recorded for any triage episode include the

following:

• Date and time of triage assessment

• Name of the Triage Nurse

• Presenting problem

• Relevant clinical assessment findings and limited relevant history

• Initial triage category allocated

• Area the patient is allocated or streamed to within the ED

• Diagnostic, first aid or treatment initiated at triage

NSW Health Policy 2012_069 Health Care Records – Documentation and Management available

http://www0.health.nsw.gov.au/policies/pd/2012/PD2012_069.html

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• Type of visit code.

Any change in the patient’s condition prior to being seen by the treating clinician must be

documented clearly. If re-triage is required; documentation should include

• The time of re-triage

• Reason for the re-triage

• Information about escalation of the patient’s change in condition to relevant senior

ED staff.

Documentation regarding patients that choose to leave the ED without treatment should

detail as much information as is available, including the following:

• information given to the patient or carer regarding the need to stay for treatment

• advice given regarding alternative or ongoing care

• the name and position of the clinician that concerns were escalated to

• the patient’s condition on departure

• the time that the patient left

• any action that was taken subsequent to the patient leaving

• any other relevant information.

2 COMPONENTS OF THE TRIAGE PROCESS

2.1 The Purpose and role of Triage

Triage is a critical component in the delivery of emergency care, and is the first point of

contact and assessment in the patient’s ED journey.

The purpose and role of triage is to

first identify patients with life-threatening or emergency conditions and initiate appropriate

interventions (eg. emergency first aid as per local protocols), then second, allocate the

patient to an appropriate area or stream within the ED.

ED and Hospital processes must support the ability of triage to be carried out within five

minutes so as not to delay other patients awaiting triage. This includes limiting the

responsibilities and additional tasks required of the Triage Nurse, where appropriate, so

that focus can remain on timely triage of patients as they enter the ED.

Triage is used to determine the patient’s clinical urgency; it is not an indicator of

complexity of the patient’s condition and should not be used as a substitute for this.

Triage involves rapid patient assessment, interpretation of the clinical history and

physiological assessment, while objectively discriminating between the ATS categories of

urgency. Triage decision-making is inherently complex, made under conditions of

uncertainty and with limited or obscure information.

Hodge, A., et al., A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications

for future practice. Australasian Emergency Nursing Journal, 2013. 16(1): p. 21-29.

Triage of Patients in NSW Emergency Departments

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Assessment of clinical urgency is achieved by observation of general appearance,

collection of a focused history to identify presenting problem and clinical risk and

collections and interpretation of physiological data using a primary survey approach

It is the responsibility of the Triage Nurse to escalate and engage further assistance from

senior ED clinical staff where appropriate.

It is recognised that the triage process relates to managing the queue of patients who

present for treatment. Currently this is done consistently by Triage Nurses, however EDs

may choose to implement strategies to manage the queue according to local needs (for

example, decision making clinicians seeing patients immediately on arrival to the ED).

It is important that the Triage Nurse is competent in identifying and promoting cultural

safety for patients that are triaged including access to interpreter services, notification of

Aboriginal Liaison Officers where appropriate and is able to access culturally appropriate

information regarding triage and the waiting room for patients.

2.2 Use of the Australasian Triage Scale

In all NSW EDs, emergency nurses perform the triage role using the ATS. The ATS is a

five-point scale used to prioritise patients. An ATS category from one to five is allocated

according to the maximum time the Triage Nurse determines the patient can wait for

emergency care.

The Triage Nurse applies an ATS category in response to the question “this patient should

wait for assessment and treatment by a treating clinician no longer than...”

ATS Category

Treatment Acuity

(maximum waiting time)

Performance Indicator Threshold*

ATS 1 Immediate 100%

ATS 2 10 minutes 80%

ATS 3 30 minutes 75%

ATS 4 60 minutes 70%

ATS 5 120 minutes 70%

* Performance Indicator Threshold represents the percentage of patients assigned ATS Category 1 through

to 5 who commence clinical assessment and treatment within the relevant waiting time from their time of

arrival.

2.3 Re-triage of patients with deteriorating conditions

It is recognised that triage is a dynamic process and may require that the patient be re-

triaged if their condition changes, deteriorates or additional relevant information is received

prior to being seen by a treating clinician”

ACEM Policy on the Australasian Triage Scale

http://www.acem.org.au/media/policies_and_guidelines/P06_Aust_Triage_Scale_-_Nov_2000.pdf

Triage of Patients in NSW Emergency Departments

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Such relevant information may be received via a source such as: interpreters, Drs letter,

family members, past medical records etc.

The process of re-triage involves an assessment of the waiting patient who has not been

reviewed by a clinician responsible for care. The purpose of re-triage is to acknowledge

any change in clinical condition of a patient and assign a relevant triage category. A

patient may be assessed as requiring a higher acuity triage category (due to deterioration).

Documentation is to occur detailing the assessment, application of a new triage category,

and necessary discussions or escalation of the patient’s condition to a senior ED clinician

(Registered Nurse, Medical Officer, Team Leader).

Patients and/or carers should be informed at the time of triage what to do if their condition

changes or they become concerned while waiting for care and how the triage system

works to prioritise care.

All waiting patients should be regularly assessed by either the Triage Nurse or Clinical

Initiatives Nurse (CIN) if available; particularly if the waiting time exceeds the allotted triage

category maximum waiting time.

2.4 Triage location and safety requirements

The triage environment must provide safety for the public, the Triage Nurse, staff and

patients of the ED. The triage environment must take into account the potential risk of

aggressive behaviour of patients or their relatives.

The environment:

• Must be immediately visible and well sign posted

• Must allow for clear visibility of the waiting room by the Triage Nurse

• Must have access to an area for patient examination and provision of first aid

• Must be designed to maximize the safety of the Triage Nurse, staff and patients (eg.

duress alarms, egress routes for staff exiting the triage room and access to security

personnel)

• Should enable and facilitate patient privacy (a private consultation room is

recommended for patient examination).

2.5 Triage education

It is recognised that triage should be completed by specifically trained and experienced

RNs

as:

… clinical decisions made by triage nurses require complex cognitive

process. The Triage Nurse must demonstrate the capacity for critical

thinking in environments where available data is limited, incomplete or

ambiguous.

The Registered Nurse must demonstrate clinical expertise in emergency nursing prior to

commencing triage education and training.

Australasian College for Emergency Medicine (2006) Policy on the Australasian Triage Scale

College of Emergency Nursing Australasia (2009) Position Statement Triage Nurse

Triage of Patients in NSW Emergency Departments

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The LHD will determine the baseline level of clinical expertise expected of a prospective

Triage Nurse; however, new graduate (transitional) nurses should not be eligible to

undertake a triage education program. The following is recommended as baseline clinical

expertise

• One-two years full time ED nursing experience (this does not include the New

Graduate year)

• Successful completion of the NSW Health ‘Transition to Practice, Emergency

Nursing Program’ or equivalent transitional program

• Completion of the Clinical Excellence Commission (CEC)

o Between the Flags program

o D.E.T.E.C.T.

o D.E.T.E.C.T. junior

• Advanced Life Support accreditation

• NSW Health Paediatric Clinical Practice Guidelines e-learning package

Local decision making should be applied by ED Nursing Managers, Clinical Nurse

Consultants and Nurse Educators on readiness of nurses to undertake the triage role

where appropriate. Local systems should be in place for Recognition of Prior Learning to

ascertain an equivalent level of the development of clinical expertise.

It is the responsibility of the LHD Executive, the Medical Director of the ED (or equivalent),

the Nurse Manager of the ED (or equivalent) and LHD Nursing Education service to

ensure an adequately resourced, locally relevant, comprehensive triage training and

assessment program. It is recommended that the program should encompass the

following elements:

• It should be based on the Emergency Triage Education Kit

(ETEK)

• It should not teach ETEK in isolation, but use it as part of a training and competency

based triage program

• It should include information about local procedures, processes and nuances.

• It should provide supernumerary support during practical triage training

• It should ensure that novice triage nurses have access to senior medical and

nursing staff for support as they learn the triage role (either in person or via

appropriate telecommunications)

At the completion of a triage training program, the Triage Nurse must be able to

demonstrate knowledge and/or competence as follows:

• Recall the science and practice of triage

• Outline the Australian health care system

Health Policy Priorities Principle Committee (2011) Australian Triage Process Review

Clinical Excellence Commission (2013) Between the Flags

NSW Ministry of Health (2010) Paediatric Clinical Practice Guidelines e-learning package

Australian Department of Health and Aging (2009) Emergency Triage Education Training Kit

Adapted from College of Emergency Nursing Australasia (2009) Position Statement Triage Nurse

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• Describe the role of the Triage Nurse

• Apply the ATS

• Relate the legislative requirements and considerations

• Discuss epidemiology and population health

• Demonstrate effective communication skills including use of electronic medical

record systems where appropriate.

• Application of the primary and secondary surveys

• Apply and synthesize an assessment and triage decision making process by the

following presentation types:

o Trauma

o Medical and surgical emergencies

o Older persons emergencies and delirium identification

o Paediatric emergencies

o Obstetric and gynaecological emergencies

o Mental health emergencies and the Mental Health Act 2007

o Rural and isolated triage practice

o Environmental emergencies

• Discuss quality and safety in health care and apply it to triage decision making.

• Discuss cultural safety issues and ensure cultural competence of triage staff

It is recognised that in hospitals with ED role delineation level 1 & 2, there may be

occasional circumstances when an Enrolled Nurse is the first point of contact for a patient

arriving in the ED.

For these contingencies, hospitals must:

1. Have clear processes established in order to rapidly notify a registered nurse of

the patient's arrival.

2. Note that Registered Nurses are responsible for formal triaging in all

circumstances.

3. Establish training for those Enrolled Nurses likely to encounter these

circumstances so that they are equipped to identify high acuity patients.

Ongoing evaluation of performance, updates of clinical practice and professional

development must be in place to ensure currency of knowledge and practice for the role of

Triage Nurse.

2.6 Triage of Ambulance patients

Patients arriving to the ED via ambulance will be assessed and triaged as per normal ED

triage procedures.

Some LHDs may have local protocols in place for rapid triage/triage bypass of specific

clinical groups (e.g. ST Elevation Myocardial Infarction, Trauma, Sepsis and Stroke). LHDs

are required to ensure that all triage staff are aware of local protocol agreements relating

to the triage of specific clinical groups within their ED.

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Following triage assessment, the Triage Nurse will determine the most appropriate

location within the ED to facilitate transfer of care of patients presenting by ambulance and

release of paramedics from care of the patient. This will include allocation of patients to

defined clinical areas within the ED or transfer to the waiting room where appropriate,

particularly low acuity and low complexity patients for whom staying on the ambulance

stretcher is not necessary.

To facilitate Transfer of Care, a clinical handover using a structured approach such as

‘IMIST AMBO’, must occur between the treating Paramedic and accepting ED clinician.

Transfer of Care is deemed complete only when this clinical handover has occurred and

the patient has been offloaded from the ambulance stretcher and/or the care of the

ambulance paramedics is no longer required.

In the event, that the patient is unable to be offloaded from the ambulance stretcher to an

appropriate location within the ED, joint care and monitoring of the patient by ED staff and

paramedics will continue until the patient can be offloaded. Transfer of Care should occur

as soon as possible.

2.7 Telephone advice

It is not the role or responsibility of the Triage Nurse to provide clinical telephone advice to

the public, carers and non-health professionals who may telephone the ED in an attempt

to seek emergency and other medical advice.

If the Triage Nurse identifies that a caller is requiring general medical advice they should

direct the caller to phone the National Triage Telephone Advice Line (healthdirect

Australia) on 1800 022 222. If the Triage Nurse identifies that the call may be of an

emergency nature, the Triage Nurse should direct the caller to hang up and phone 000 for

assistance. If the Triage Nurse identifies that a caller is ringing about a mental health

problem, they should direct the caller to phone the NSW Mental Health Line on

1800 011 511.

2.8 Mass Casualty Disaster and Triage

This procedure document outlines the process for ED triage under ‘usual’ circumstances.

Mass casualty triage, while similar, is distinct from the triage process that has been

described in this document. During mass casualty incidents, or ‘disasters’ the triage

process may change. This decision will be made by a hospital disaster controller, or their

delegate.

http://www0.health.nsw.gov.au/policies/gl/2010/GL2010_011.html

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LIST OF RELATED DOCUMENTS

1. Australasian College for Emergency Medicine policy on the Australasian Triage

Scale available:

http://www.acem.org.au/media/policies_and_guidelines/P06_Aust_Triage_Scale_-

_Nov_2000.pdf

2. Australasian College for Emergency Medicine guidelines on the implementation of

the Australasian Triage Scale in Emergency Departments available:

http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation__ATS.

pdf

3. College of Emergency Nursing Australasia position statement: Triage Nurse

available: http://cena.org.au/CENA/Documents/CENATriageNursePSJuly2009.pdf

4. College of Emergency Nursing Australasia Position Statement: Triage and the

Australasian Triage Scale

http://cena.org.au/CENA/Documents/2012_06_14_CENA_-

_Position_Statement_Triage_FinalD2-1.pdf

5. Australian Triage Process Review report available:

http://www.ecinsw.com.au/sites/default/files/field/file/Australian%20Triage%20Proce

ss%20Review.pdf

6. Emergency Triage Education Kit available:

http://www.health.gov.au/internet/main/publishing.nsf/Content/casemix-ED-

Triage+Review+Fact+Sheet+Documents

7. Emergency Department Triage Method available:

http://www.ecinsw.com.au/sites/default/files/field/file/Triage%20Method-

Oct%202010-2.pdf

8. NSW Health Emergency Department Models of Care July 2012 available:

http://www0.health.nsw.gov.au/pubs/2012/pdf/ed_model_of_care_2012.pdf

9. NSW Health Policy PD2005_315 Zero Tolerance Response to Violence in the NSW

Health Workplace available:

http://www0.health.nsw.gov.au/policies/PD/2005/PD2005_315.html

10. NSW Health Policy PD2007_036 Infection Control Policy available:

http://www0.health.nsw.gov.au/policies/pd/2007/PD2007_036.html