Supporting Statement Part B_ESI final

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

ASSESSMENT OF THE EMERGENCY SEVERITY INDEX (ESI)

SU_ID:

Thank you for participating in the assessment of the Emergency Severity Index (ESI). We appreciate your candid feedback on the ESI. The survey should take no more than 20 minutes to complete and your answers will be kept confidential. We encourage you to take this survey online. Please go to http://www.xxxx.xxx and follow the instructions on the screen.

GENERAL INSTRUCTIONS

Answer all the questions by checking the box to the left of your answer. You are sometimes told to skip over some questions in this survey. If this happens, you will see an arrow with a note that tells you what questions to answer next, like this:

¹ _ Yes

² _ No  SKIP TO SECTION V

P ublic reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to complete the survey. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

SECTION I: BACKGROUND

If you work for more than one hospital, please answer the questions from the perspective of the hospital in which you spend most time.

1 a. Do you work in a hospital?

¹ _ Yes

² _ No  SKIP TO SECTION V

1 b. Do you work in an emergency department (ED)?

¹ _ Yes

² _ No

2. Does this hospital train medical students or residents?

¹ _ Yes

² _ No

3. Is this hospital part of a multi-hospital corporation?

¹ _ Yes

² _ No

4. What type of hospital do you work in?

¹ _ Government-owned facility (owned by the federal government or a state, county, or municipal government)

² _ Privately-owned/ nonprofit facility

³ _ Investor-owned/ for-profit facility

5. Is your facility a Critical Access Hospital?

¹ _ Yes

² _ No

6. Is your ED staffed 24 hours per day/ seven days per week?

¹ _ Yes

² _ No

7. What is the zip code of the hospital you work in?

Write hospital zip code here: ______

8. Which of the following best describes your job in the hospital?

¹ _ Emergency Department Nurse Manager

² _ Emergency Department Medical Director

³ _ Emergency Department Director of Nursing

⁴ _ Clinical Nurse Educator/Trainer

⁵ _ Director of Education/ Staff Development

⁶ _ Emergency Physician

⁷ _ Emergency Nurse

⁸ _ Emergency Technician

⁹ _ Medical Assistant

¹⁰ _ Administrative/ Clerical Staff

¹¹ _ Resident

¹² _ Other (please specify):

9. What was the ED’s annual number of patient visits in 2007?

Write annual number of visits here: ______

10. What was your ED’s admission rate in 2007?

Write admission rate here in %: ______

11. What was your ED’s average length of stay (LOS) in days, in 2007?

Write average LOS here in # of days here:

______

12. What was the left-without-being-seen (LWBS) rate in 2007? (LWBS refers to any patient who leaves the ED before initiation of the medical screening exam.)

Write %: ______

13. Is your hospital a Level I or II trauma center? Please select one option.

¹ _ Level 1

² _ Level 2

³ _ Other

14a. Are you aware of the Emergency Severity Index (ESI) 5-level triage methodology?

¹ _ Yes

² _ No

14b. How did you first become aware of the ESI?

¹ _ Agency for Healthcare Research and Quality (AHRQ) website

² _ AHRQ, other than the website

³ _ Emergency medical conference

⁴ _ Professional conference other than for emergency medicine

⁵ _ Used in my ED

⁶ _ Published literature

⁷ _ Medical school coursework

⁸ _ Word of mouth

⁹ _ Other (please specify):

15. Does your emergency department use the ESI as its primary ED triage tool for every day use (non-catastrophic situations)?

¹ _ Yes

² _ No, but considering implementation
of the ESI  SKIP to SECTION III

³ _ No, not considering implementation of the ESI at this time  SKIP to SECTION IV

SECTION II. USERS OF THE ESI

The following questions are about the use of the ESI in your ED.

1. How long has your ED used the ESI as the primary triage tool?

¹ _ Less than 3 months

² _ Between 3 – 6 months

³ _ Between 7 – 12 months

⁴ _ Between 1 – 2 years

⁵ _ Between 3 – 5 years

6 _ More than 5 years

⁷ _ Other (please specify):

⁸ _ Don’t know

2. Does your ED use other tools for triage in addition to the ESI (for example, as part of a community-wide catastrophe response plan)?

¹ _ Yes

² _ No  SKIP TO QUESTION 5

3. What other type of triage system does your emergency department use?

¹ _ 2 levels

² _ 3 levels

³ _ 4 levels

⁴ _ 5 levels – Australasian Triage Scale (ATS) formerly National Triage Scale of Australia – resuscitation, emergent, urgent, semi-urgent, non-urgent

⁵ _ 5 levels – Manchester – immediate, very urgent, urgent, standard, non-urgent

⁶ _ 5 levels – Canadian Triage and Acuity Scale (CTAS) – resuscitation, emergent, urgent, less urgent, non-urgent

⁷ _ 5 levels – Other triage system/ Don’t know the name of the triage system

⁸ _ Other (please specify):

⁹ _ Don’t know

¹⁰ _ My ED did not have a formal triage system in place prior to the ESI

4. For what purpose(s) is an alternative triage method used in your ED? Please describe your answer in the box below.

5. What aspects of the ESI were most influential in helping your ED to choose the ESI as the primary triage algorithm? Please select ALL that apply.

	Most Important	Important	Somewhat Important	Not Important	Least Important	NA / Don’t know
a. Ease of use	5 	4 	3 	2 	1 	0 
b. Ability to sort patients clinically	5 	4 	3 	2 	1 	0 
c. Ability to predict ED resource demand	5 	4 	3 	2 	1 	0 
d. Ability to plan staffing levels	5 	4 	3 	2 	1 	0 
e. Ability to facilitate patient flow	5 	4 	3 	2 	1 	0 
f. Use was mandated by corporate/ hospital administration	5 	4 	3 	2 	1 	0 
g. Recommendation of Emergency Nurses Association/ American College of Emergency Physicians	5 	4 	3 	2 	1 	0 
h. Recommendation of other professional organization (please specify):	5 	4 	3 	2 	1 	0 
i . Other (please specify):	5 	4 	3 	2 	1 	0 

6. In what ways, if any, did the ESI have to be adjusted in order for it to work with your ED’s operation?

7. Are you satisfied with ESI as a triage tool?

⁵ _ Very Satisfied

⁴ _ Satisfied

³ _ Somewhat Satisfied

² _ Not Really Satisfied

¹ _ Not at All Satisfied

⁰ _ NA /Don’t know

8. Has your ED monitored the impact of the ESI on any of the following? Please select all that apply.

1 _ Waiting time to see a physician

² _ Left without being seen (LWBS) rate

³ _ Average length of stay (LOS)

⁴ _ Triage accuracy

⁵ _ Patient satisfaction

⁶ _ Other:

⁷ _{ Not yet, but we plan to.}

⁸ _{ No}

We are interested in how the ESI compares to other triage tools.

9. What triage system did your emergency department use prior to implementing the ESI? Please select one answer.

¹ _ 2 levels

² _ 3 levels

³ _ 4 levels

⁴ _ 5 levels – Australasian Triage Scale (ATS) formerly National Triage Scale of Australia – resuscitation, emergent, urgent, semi-urgent, nonurgent

⁵ _ 5 levels – Manchester – immediate, very urgent, urgent, standard, nonurgent

⁶ _ 5 levels – Canadian Triage and Acuity Scale (CTAS) – resuscitation, emergent, urgent, less urgent, nonurgent

⁷ _ 5 levels – Other triage system/ Don’t know the name of the triage system

⁸ _ Other (please specify):

⁹ _ Don’t know

¹⁰ _ My ED did not have a formal triage system in place prior to the ESI  SKIP TO QUESTION 11

10. For each characteristic, please rate whether you feel that the ESI is a better or worse tool for every day use (non-catastrophic situations) when compared to the ED triage system that you used prior to the ESI.

	ESI is Much Better than other tool	ESI is Better than other tool	ESI is About the Same As other tool	ESI is Worse than other tool	ESI is Much Worse than other tool	NA/ Don’t Know
a. Ease of implementation	5 	4 	3 	2 	1 	0 
b. Ease of use	5 	4 	3 	2 	1 	0 
c. Sorting patients clinically	5 	4 	3 	2 	1 	0 
d. Predicting ED resource demand	5 	4 	3 	2 	1 	0 
e. Planning staffing levels	5 	4 	3 	2 	1 	0 
f. Facilitating patient flow in the ED	5 	4 	3 	2 	1 	0 
g. Budgeting	5 	4 	3 	2 	1 	0 
h. Overall effectiveness	5 	4 	3 	2 	1 	0 
i. Other (please specify):	5 	4 	3 	2 	1 	0 

The following questions are about the ESI training materials. Please rate the ESI training DVDs and accompanying booklet according to the following:

11. Have you reviewed the ESI handbook?

¹ _ Yes

² _ No

³ _ NA/ Did not receive handbook

12. Have you reviewed the ESI training DVDs?

¹ _ Yes

² _ No

³ _ NA/ Did not receive DVDs

13. Please rate the ESI handbook according to the following categories.

	Excellent	Good	Moderate	Poor	Very poor	NA/ Don’t know
a. Production Quality	5 	4 	3 	2 	1 	0 
b. Format	5 	4 	3 	2 	1 	0 
c. Organization	5 	4 	3 	2 	1 	0 
d. Appearance	5 	4 	3 	2 	1 	0 
e. Readability	5 	4 	3 	2 	1 	0 
f. Appropriateness of the reading level	5 	4 	3 	2 	1 	0 
g. Ability to convey instructions	5 	4 	3 	2 	1 	0 
h. Usefulness of the practice cases	5 	4 	3 	2 	1 	0 
i. Usefulness of the competency cases	5 	4 	3 	2 	1 	0 
j. Appropriateness for ED triaging staff	5 	4 	3 	2 	1 	0 
k. Comprehensiveness	5 	4 	3 	2 	1 	0 

14. Please rate the ESI DVDs according to the following categories.

	Excellent	Good	Moderate	Poor	Very poor	NA/ Don’t know
a. Production Quality	5 	4 	3 	2 	1 	0 
b. Format	5 	4 	3 	2 	1 	0 
c. Organization	5 	4 	3 	2 	1 	0 
d. Appearance	5 	4 	3 	2 	1 	0 
e. Sound	5 	4 	3 	2 	1 	0 
f. Ability to convey instructions	5 	4 	3 	2 	1 	0 
g. Usefulness of the practice cases	5 	4 	3 	2 	1 	0 
h. Appropriateness for ED triaging staff	5 	4 	3 	2 	1 	0 
i. Ease of viewing on computer	5 	4 	3 	2 	1 	0 
j. Ease of viewing on DVD player	5 	4 	3 	2 	1 	0 
k. Comprehensiveness	5 	4 	3 	2 	1 	0 

15. Please rate how effective the materials were in teaching you about the ESI.

	Very effective	Effective	Somewhat effective	Not very effective	Not at all effective	NA/ Don’t know
a. ESI Handbook	5 	4 	3 	2 	1 	0 
b. ESI DVDs	5 	4 	3 	2 	1 	0 

16. Please rate how helpful the training materials were in preparing you to implement the ESI in your ED.

	Very helpful	Helpful	Somewhat helpful	Not very helpful	Not at all helpful	NA/ Don’t know
a. ESI Handbook	5 	4 	3 	2 	1 	0 
b. ESI DVDs	5 	4 	3 	2 	1 	0 

17. Did your ED use the AHRQ ESI training materials (the DVDs and/ or accompanying handbook) to train staff about the ESI?

¹ _ Yes

² _ No

³ _ Don’t know

18. Did your ED adapt or modify the ESI training materials (the DVDs and/ or accompanying handbook) in any of the ways below? Please select all that apply.

¹ _ Used local language

² _ Used local examples for practice cases

³ _ Incorporated other ED initiatives into the material (e.g., pain scales or planned care models)

4 _ Don’t know

5 _ My ED did not modify the ESI training materials

⁶ _ Other (please describe in the box below):

19. Are any other materials besides the DVDs and accompanying handbook used to train ED staff about the ESI?

¹ _ Yes

² _ No

³ _ Don’t know

20. What other materials are used to train ED staff about ESI?

21. How did you train your staff?

¹ _ Hired outside consultants to train all staff

² _ Sent nurse educators on hospital staff to outside training

³ _ Nurse educators on hospital staff trained all ED nurses using AHRQ materials

⁴ _{ Other:}

22. Did your ED have to change any of the following when implementing the ESI? Please select all that apply.

¹ _ Paper forms/ medical records

² _ Electronic forms/ medical records

³ _ Software

4 _ Hardware

5 _{ ED information system (EDIS)}

6 _ Tracking board

7 _ Other: _____________________

8 _ Did not have to change anything

9 _ NA/ Don’t know

23. Please rate the ease with which the ESI was implemented in your ED.

¹ _ Very easy

² _ Easy

³ _ Moderately easy

⁴ _ Not very easy

5 _ Don’t know

24. Approximately how long did it take to implement the ESI, from the initial planning phase to the actual implementation of the system in your ED?

1 _{Write # of Month(s):} ________

² Check the box if you don’t know _

25. Please rate your familiarity with the Agency for Healthcare Research and Quality (AHRQ), its mission, and activities in the table below.

Please rate all that apply or select NA/Don’t Know.

	Very Familiar	Familiar	A little Familiar	Not really familiar	Not at all familiar	NA/ Don’t know
a. The Agency for Healthcare Research and Quality (AHRQ)	5 	4 	3 	2 	1 	0 
b. AHRQ’s mission	5 	4 	3 	2 	1 	0 
c. AHRQ’s activities in surge planning and emergency preparedness	5 	4 	3 	2 	1 	0 

26. Did your ED face any unexpected challenges as a result of implementing ESI in your ED? Please describe below.

27. Did your ED experience any unexpected benefits as a result of implementing ESI in your ED? Please describe below.

28. This is AHRQ’s first assessment of the ESI methodology and supporting materials. AHRQ wants the ESI and supporting materials to be as helpful as possible. Please take this opportunity to provide feedback on any aspect of the ESI methodology and/or the ESI Handbook and DVDs. Your comments will be considered in improving and updating the ESI and its supporting materials.

STOP. Thank you for participating in this survey.

SECTION III. NONUSERS OF THE ESI WHO ARE CONSIDERING ESI IMPLEMENTATION

The following questions are about the use of the ESI in your ED.

1. What type of triage system does your emergency department currently use?

¹ _ 2 levels

² _ 3 levels

³ _ 4 levels

⁴ _ 5 levels – Australasian Triage Scale (ATS) formerly National Triage Scale of Australia – resuscitation, emergent, urgent, semi-urgent, nonurgent

⁵ _ 5 levels – Manchester – immediate, very urgent, urgent, standard, nonurgent

⁶ _ 5 levels – Canadian Triage and Acuity Scale (CTAS) – resuscitation, emergent, urgent, less urgent, nonurgent

⁷ _ 5 levels – Other triage system/ Don’t know the name of the triage system

⁸ _ Other (please specify):

⁹ _ None of the above

2. What aspects of the ESI have led you to consider implementing the ESI in your ED?

Please rate all that apply or select NA/Don’t Know.

	Most Important	Important	Somewhat Important	Not Important	Least Important	NA/ Don’t Know
a. Ease of use	5 	4 	3 	2 	1 	0 
b. Ability to sort patients clinically	5 	4 	3 	2 	1 	0 
c. Ability to predict ED resource demand	5 	4 	3 	2 	1 	0 
d. Ability to plan staffing levels	5 	4 	3 	2 	1 	0 
e. Ability to facilitate patient flow	5 	4 	3 	2 	1 	0 
f. Budgeting	5 	4 	3 	2 	1 	0 
g. Other (please specify)	5 	4 	3 	2 	1 	0 

3. Do you see any barriers to implementing the ESI in your ED? Using the scale below, please indicate the degree to which each of the listed items may be barriers to preventing the implementation of the ESI in your ED.

Please rate all that apply or select NA/Don’t Know.

	Does not Prevent		Somewhat Prevents		Strongly prevents	NA/ Don’t Know
a. Unfamiliar with the ESI	5 	4 	3 	2 	1 	0 
b. Costs associated with training ED staff	5 	4 	3 	2 	1 	0 
c. Fear of cultural change in the ED	5 	4 	3 	2 	1 	0 
d. Happy with current system	5 	4 	3 	2 	1 	0 
f. ESI is too complicated	5 	4 	3 	2 	1 	0 
g. Not convinced the ESI is a better method	5 	4 	3 	2 	1 	0 
h. Not convinced it is worth the effort to change to the ESI	5 	4 	3 	2 	1 	0 
i. Afraid that there will not be widespread acceptance of the ESI among ED staff	5 	4 	3 	2 	1 	0 
j. Costs association with modifying systems to accommodate ESI (e.g. medical records, software, forms)	5 	4 	3 	2 	1 	0 
k. The hospital or ED is addressing other important priorities	5 	4 	3 	2 	1 	0 
l. Other (please specify):	5 	4 	3 	2 	1 	0 

The following questions are about the ESI training materials. Please rate the ESI training DVDs and accompanying booklet according to the following:

4. Have you reviewed the ESI training DVDs?

¹ _ Yes

² _ No

³ _ NA/ Did not receive DVDs

5. Have you reviewed the ESI handbook?

¹ _ Yes

² _ No

³ _ NA/ Did not receive handbook

6. Please rate the ESI handbook according to the following categories.

	Excellent	Good	Moderate	Poor	Very poor	NA/ Don’t know
a. Production Quality	5 	4 	3 	2 	1 	0 
b. Format	5 	4 	3 	2 	1 	0 
c. Organization	5 	4 	3 	2 	1 	0 
d. Appearance	5 	4 	3 	2 	1 	0 
e. Readability	5 	4 	3 	2 	1 	0 
f. Appropriateness of the reading level	5 	4 	3 	2 	1 	0 
g. Ability to convey instructions	5 	4 	3 	2 	1 	0 
h. Usefulness of the practice cases	5 	4 	3 	2 	1 	0 
i. Usefulness of the competency cases	5 	4 	3 	2 	1 	0 
j. Appropriateness for ED triaging staff	5 	4 	3 	2 	1 	0 
k. Comprehensiveness	5 	4 	3 	2 	1 	0 

7. Please rate the ESI DVDs according to the following categories.

	Excellent	Good	Moderate	Poor	Very poor	NA/ Don’t know
a. Production Quality	5 	4 	3 	2 	1 	0 
b. Format	5 	4 	3 	2 	1 	0 
c. Organization	5 	4 	3 	2 	1 	0 
d. Appearance	5 	4 	3 	2 	1 	0 
e. Sound	5 	4 	3 	2 	1 	0 
f. Ability to convey instructions	5 	4 	3 	2 	1 	0 
g. Usefulness of the practice cases	5 	4 	3 	2 	1 	0 
h. Appropriateness for ED triaging staff	5 	4 	3 	2 	1 	0 
i. Ease of viewing on computer	5 	4 	3 	2 	1 	0 
j. Ease of viewing on DVD player	5 	4 	3 	2 	1 	0 
k. Comprehensiveness	5 	4 	3 	2 	1 	0 

8. Please rate how effective the materials were in teaching you about the ESI.

	Very effective	Effective	Somewhat effective	Not very effective	Not at all effective	NA/ Don’t know
a. ESI Handbook	5 	4 	3 	2 	1 	0 
b. ESI DVDs	5 	4 	3 	2 	1 	0 

9. Please rate how helpful the training materials were in preparing you to implement the ESI in your ED.

	Very helpful	Helpful	Somewhat helpful	Not very helpful	Not at all helpful	NA/ Don’t know
a. ESI Handbook	5 	4 	3 	2 	1 	0 
b. ESI DVDs	5 	4 	3 	2 	1 	0 

10. Do you have plans to use the ESI training materials (the DVDs and/ or accompanying handbook) to train ED staff about the ESI?

¹ _ Yes

² _ No

³ _ NA/ Don’t know

11. Are there any other materials besides the DVDs and accompanying handbook that you plan to use in order to train ED staff about the ESI?

¹ _ Yes

² _ No  SKIP TO QUESTION 13

³ _ NA/Don’t know  SKIP TO QUESTION 13

12. What other materials will be used to train ED staff about the ESI?

13. Please rate your familiarity with the Agency for Healthcare Research and Quality (AHRQ), its mission, and activities in the table below.

Please rate all that apply or select NA/Don’t Know.

	Very Familiar	Familiar	A little Familiar	Not really familiar	Not at all familiar	NA/ Don’t know
a. The Agency for Healthcare Research and Quality (AHRQ)	5 	4 	3 	2 	1 	0 
b. AHRQ’s mission	5 	4 	3 	2 	1 	0 
c. AHRQ’s activities in surge planning and emergency preparedness	5 	4 	3 	2 	1 	0 

14. This is AHRQ’s first assessment of the ESI methodology and supporting materials. AHRQ wants the ESI and supporting materials to be as helpful as possible. Please take this opportunity to provide feedback on any aspect of the ESI methodology and/or the ESI Handbook and DVDs. Your comments will be considered in improving and updating the ESI and its supporting materials.

STOP. Thank you for participating in this survey.

SECTION IV.
NONUSERS WHO ARE NOT CONSIDERING THE ESI IMPLEMENTATION AT THIS TIME

1. What type of triage system does your ED use every day?

¹ _ 2 levels

² _ 3 levels

³ _ 4 levels

⁴ _ 5 levels – Australasian Triage Scale (ATS) formerly National Triage Scale of Australia – resuscitation, emergent, urgent, semi-urgent, non-urgent

⁵ _ 5 levels – Manchester – immediate, very urgent, urgent, standard, non-urgent

⁶ _ 5 levels – Canadian Triage and Acuity Scale (CTAS) – resuscitation, emergent, urgent, less urgent, non-urgent

⁷ _ 5 levels – Other triage system/ Don’t know the name of the triage system

⁸ _ Other (please specify):

⁹ _ No triage tool is used in my ED

2. In this question, we would like to know about the barriers to implementing the ESI in your ED. Using the scale below, please indicate the degree to which each of the listed items may be barriers to preventing the implementation of the ESI in your ED. Please rate all that apply or select NA/Don’t Know.

	Does not Prevent		Somewhat Prevents		Strongly prevents	NA/ Don’t Know
a. Unfamiliar with the ESI	5 	4 	3 	2 	1 	0 
b. Costs associated with training ED staff	5 	4 	3 	2 	1 	0 
c. Fear of cultural change in the ED	5 	4 	3 	2 	1 	0 
d. Happy with current system	5 	4 	3 	2 	1 	0 
f. ESI is too complicated	5 	4 	3 	2 	1 	0 
g. Not convinced the ESI is a better method	5 	4 	3 	2 	1 	0 
h. Not convinced it is worth the effort to change to the ESI	5 	4 	3 	2 	1 	0 
i. Afraid that there will not be widespread acceptance of the ESI among ED staff	5 	4 	3 	2 	1 	0 
j. Costs association with modifying systems to accommodate ESI (e.g. medical records, software, forms)	5 	4 	3 	2 	1 	0 
j. The hospital or ED is addressing other important priorities	5 	4 	3 	2 	1 	0 
k. Other (please specify):	5 	4 	3 	2 	1 	0 

3. Have you reviewed the ESI training DVDs?

¹ _ Yes

² _ No

³ _ NA/ Did not receive DVDs

4. Have you reviewed the ESI handbook?

¹ _ Yes

² _ No

³ _ NA/ Did not receive handbook

5. Is the reason that you did not implement the ESI in your ED because you felt that the training materials (ESI Handbook and DVDs) did not adequately prepare you to implement the ESI?

¹ _ Yes

² _ No, the ESI was not implemented for other reasons

³ _ The ESI was never under consideration at my ED

⁴ _ Don’t know

6. Please rate your familiarity with the Agency for Healthcare Research and Quality (AHRQ), its mission, and activities in the table below.

Please rate all that apply or select NA/Don’t Know.

	Very Familiar	Familiar	A little Familiar	Not really familiar	Not at all familiar	NA/ Don’t know
a. The Agency for Healthcare Research and Quality (AHRQ)	5 	4 	3 	2 	1 	0 
b. AHRQ’s mission	5 	4 	3 	2 	1 	0 
c. AHRQ’s activities in surge planning and emergency preparedness	5 	4 	3 	2 	1 	0 

7. This is AHRQ’s first assessment of the ESI methodology and supporting materials. AHRQ wants the ESI and supporting materials to be as helpful as possible. Please take this opportunity to provide feedback on any aspect of the ESI methodology and/or the ESI Handbook and ESI DVDs or on ED triaging, in general. Your comments will be considered in improving and updating the ESI and its supporting materials.

STOP. Thank you for participating in this survey.

SECTION V. ESI REQUESTERS FROM A NONHOSPITAL SETTING

1. In general, what type of organization do you work for? (e.g., research, government agency, medical school, etc.) Please select only one response.

¹ _ Consulting Services

² _ Research Services

³ _ Government & Policy

⁴ _ Medical School

⁵ _ Administrative & Support Services

⁶ _ Education and Training

⁷ _ Financial Services

⁸ _ Human Resources

⁹ _ Information Technology

¹⁰ _ Insurance

¹¹ _ Legal

¹² _ Sales

¹³ _ Other

2a. Are you aware of the Emergency Severity Index (ESI) 5-level triage methodology?

¹ _ Yes

² _ No  SKIP TO QUESTION 3

2b. How did you first become aware of the ESI?

¹ _ Agency for Healthcare Research and Quality (AHRQ) website

² _ AHRQ, other than the website

³ _ Emergency medical conference

⁴ _ Professional conference other than for emergency medicine

⁵ _ Used in my ED

⁶ _ Published literature

⁷ _ Medical school coursework

⁸ _ Word of mouth

⁹ _ Other (please specify):

3. Why did you request the AHRQ ESI training materials?

4. Please indicate whether you have reviewed the ESI training materials by selecting ONE of the following responses.

¹ _ Reviewed only the ESI handbook

² _ Reviewed only the ESI DVDs

³ _ Reviewed both the ESI handbook and DVD

⁴ _ Did not review either the ESI handbook or ESI DVD

⁵ _{ Did not receive the DVDs/ handbook.}

5. Please rate your familiarity with the Agency for Healthcare Research and Quality (AHRQ), its mission, and activities in the table below.

Please rate all that apply or select NA/Don’t Know.

	Very Familiar	Familiar	A little Familiar	Not really familiar	Not at all familiar	NA/ Don’t know
a. The Agency for Healthcare Research and Quality (AHRQ)	5 	4 	3 	2 	1 	0 
b. AHRQ’s mission	5 	4 	3 	2 	1 	0 
c. AHRQ’s activities in surge planning and emergency preparedness	5 	4 	3 	2 	1 	0 

6. This is AHRQ’s first assessment of the ESI methodology and supporting materials. AHRQ wants the ESI and supporting materials to be as helpful as possible. Please take this opportunity to provide feedback on any aspect of the ESI methodology and/or the ESI Handbook and ESI DVDs or on ED triaging, in general. Your comments will be considered in improving and updating the ESI and its supporting materials.

STOP. Thank you for participating in this survey.