EMERGENCY NURSE July 2009 | Volume 17 | Number 4 16 Feature THE PURPOSE of triage is to assess quickly and safely the need for care, level of care and priority, but not to diagnose. When systems of triage are introduced into emergency departments (EDs), staff have three options: adopt an existing, well-recognised and validated method; develop a national triage model that is suited to national needs; or design a local model that reflects specific needs and interests. Irrespective of the option chosen, the selected model must be used to identify patients at risk and to help clinicians make accurate assessments. But it should also ensure that patients’ specific needs, for example those of older people or people with special needs, are taken into account. The authors undertook a review of the literature to trace the development of triage as a concept over the past 60 years and examine the systems most widely used today. This review revealed that there are no triage models designed with specific patient populations in mind. Development of triage Triage has developed over the past few decades into an integral and essential part of patient care that is used in almost all EDs and pre-hospital settings world-wide. The authors’ literature review was undertaken to develop a critique of the research questions used in each model, to examine their methodologies and to determine the design of future studies. The CINAHL and Medline databases were searched using combinations of the keywords ‘triage’, ‘history’, ‘nurse’ and ‘emergency care’. Twenty articles were included in the study, with articles on disaster and telephone triage being excluded. 1950s and 1960s Triage evolved from a military to a civil practice in the United States when civilian authorities started to organise themselves to evaluate and care for injured people in the event of nuclear attack (Coffey and Growden 1952). At this time, doctors in the US were changing their work patterns as they moved away from providing general health care and home visits towards offering specialist care. This meant that community-based surgeries were often closed, especially at night and during holidays, leading to a dramatic increase in demand for hospital emergency services. This rise in the number of people attending EDs without needing immediate emergency care forced ED staff to devise a system to prioritise patients. The model they adopted was inspired by the military triage method, but with one important difference: the patients with the greatest need would be attended to first (Agency for Healthcare Research and Quality (AHRQ) 2005). Initially, ED doctors performed triage and determined patients’ need for care. In 1962, however, Parkland Hospital, in Dallas TX, became the first in the US to introduce nurse-directed and nurse-performed triage, and in so doing became a model for other EDs (Parkland Health and Hospital System 2009). Summary Several triage methods have been developed and adopted around the world but none has been devised for specific patient populations such as older people or those with special needs. This literature review outlines the development of triage since the 1950s, briefly discusses some of the models in use around the world, including one that is used in the care of older people, and outlines the issues that should be taken into account when deciding which method to adopt. Keywords Triage methods, military triage Analysis of triage worldwide Eric Fortes Lähdet and colleagues explore the issues that emergency department staff should consider when choosing the appropriate patient assessment method