EMERGENCY DEPARTMENT STANDARDS MAP
A structured guide outlining triage expectations, assessment timelines, diagnostic responsibilities, and escalation protocols in the Emergency Department.
The Emergency Department (ED) is a high‑acuity environment where delays, missed assessments, and communication failures can rapidly lead to harm. This Standards Map outlines what should occur from the moment a patient arrives through triage, assessment, diagnostics, treatment, and disposition.
Use this tool to evaluate breach, identify delays, and strengthen litigation strategy in ED‑related cases.
TRIAGE STANDARDS
✔ Immediate Triage on Arrival
• Patient must be triaged promptly upon arrival
• Triage nurse must assign an acuity level (ESI or facility equivalent)
• High‑acuity patients must be taken directly to treatment
✔ Required Triage Assessments
• Vital signs
• Pain assessment
• Chief complaint
• Mental status
• Risk factors (stroke, sepsis, cardiac, trauma, etc.)
✔ Red Flags That Require Immediate Action
• Chest pain
• Shortness of breath
• Altered mental status
• Stroke symptoms
• Sepsis indicators
• Uncontrolled bleeding
INITIAL NURSING ASSESSMENT
✔ Comprehensive Assessment
• Full set of vitals
• Focused assessment based on complaint
• Pain reassessment
• Medication/allergy review
• Fall risk assessment
✔ Required Documentation
• Time of assessment
• Findings
• Interventions initiated
• Notifications made
✔ Required Monitoring
• Repeated vitals based on acuity
• Continuous monitoring for high‑risk patients
• Pain reassessment within required timeframes
PHYSICIAN / PROVIDER EVALUATION
✔ Timely Provider Evaluation
• High‑acuity patients: immediate or rapid evaluation
• Moderate acuity: timely evaluation based on triage level
✔ Required Provider Actions
• History and physical
• Differential diagnosis
• Diagnostic orders (labs, imaging, EKG)
• Medication orders
• Reassessment after interventions
✔ Communication Requirements
• Clear documentation of findings
• Timely updates to nursing staff
• Escalation if patient deteriorates
DIAGNOSTICS & INTERVENTIONS
✔ Required Diagnostic Timelines
• EKG within minutes for chest pain
• Stroke evaluation within minutes
• Labs drawn promptly
• Imaging ordered and completed without delay
✔ Required Interventions
• Pain management
• IV fluids
• Oxygen
• Medications (antibiotics, cardiac meds, etc.)
• Fall precautions
✔ Red Flags
• Delayed EKG
• Delayed imaging
• Delayed antibiotics
• Missed abnormal vital signs
CHANGE‑IN‑CONDITION RESPONSE
✔ Required Actions When Patient Deteriorates
• Immediate reassessment
• Notify provider
• Escalate to charge nurse
• Activate rapid response or code team if needed
• Increase monitoring
✔ Required Documentation
• Time deterioration noted
• Actions taken
• Provider response
• Patient outcome
✔ Breach Indicators
• Delayed recognition
• Delayed escalation
• Lack of reassessment
• Missing documentation
DISPOSITION & HANDOFF
✔ Safe Disposition Requirements
• Clear discharge instructions
• Follow‑up plan
• Medication reconciliation
• Return‑to‑ED precautions
✔ Admission Requirements
• Timely handoff to inpatient team
• Accurate SBAR communication
• Documentation of clinical status
✔ Transfer Requirements
• Stabilization prior to transfer
• Communication with the receiving facility
• Complete transfer documentation
COMMON ED BREACH POINTS
• Delayed triage
• Missed red flags
• Delayed provider evaluation
• Delayed diagnostics
• Failure to reassess
• Failure to escalate
• Poor communication
• Missing or inaccurate documentation
These are the most common breach indicators in ED litigation.