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Topic outline
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Emergency Triage
Welcome to the Emergency Triage Hub. Here you can learn about the history of the Manchester Triage System and how it's now used around the world. You can see how it could benefit your Organisation and try some sample teaching materials.
Current Emergency Triage instructors can find all their resources by clicking on the buttons above or scrolling to the section you want. You must be logged in to see these sections.
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Read the article here
'Making more nurses, one minute at a time:
an efficiency and quality improvement project
in emergency triage' an article by Anna Mackway-Jones, Rachael Hornby, Kevin Mackway-Jones -
We’ve launched new Hub pages for each Manchester Triage System tool. These pages will contain everything you need to know about each tool from the background and methodology to Instructor teaching materials and resources. We hope these Hub pages will make it easier for you to find what you’re looking for. We’re still adding content to the pages so more things will appear over the next few weeks. We’re also revising our e-learning topics and will be launching those soon.
The new menu bar above contains links to all the Hub pages, as well as pages to help you navigate the rest of the site, access your current courses and contact us if you’ve got any questions.
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Every day, Emergency Departments are faced with increasing numbers of patients suffering from a wide range of problems; from minor illness and injury to major trauma and life threatening conditions. In order to ensure patient safety, it is essential that patients are seen in order of clinical priority and not in order of attendance.
Early Emergency Department triage was intuitive rather than methodological, and rather than being based on clinical evidence, it was based on the practitioners' own experience and clinical judgement; making it neither consistent nor auditable. The use of the Manchester Triage System ensures that a consistent approach to patient assessment and prioritisation is maintained allowing for robust audit and increased patient safety.
The Manchester Triage System is a clinical risk management tool used by clinicians worldwide to enable them to safely manage patient flow when clinical need far exceeds capacity. It is a professional, expert system and the most, rather than the least experienced personnel in the department should be using it.
The Manchester Triage System (MTS) was developed solely for registered Health Care Professionals due to the clinical skills and knowledge required in performing a triage assessment. MTG will not support organisations allowing the use of MTS by staff who are non-HCPs. In any medical negligence proceedings where the court requests evidence, MTG will send a letter to this effect.
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There are 53 MTS charts which are presentation, not diagnosis based. Charts are based on what the patient says is happening, not what may be the cause.
The MTS uses common names, discriminators and definitions in order to maintain consistency, safety and to allow robust auditing.
It is a reductive system, starting from the premise that the patient is presenting with a life threatening condition and all high priority discriminators must be ruled out prior to reducing the patient priority. This ensures the safety of the system and that no serious patient conditions are missed. Decisions made regarding patient outcome are a clinical judgement made by the clinician; and as long as the MTS is used accurately the system will be safe.
Although not designed as a streaming tool, the MTS can assist in streaming patients to the most appropriate pathway of care. However, the triage priority is a clinical indicator and is absolute; the management of particular patient will depend on department priorities and services available; management of patients should never be confused with a patients clinical priority.
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Emergency Triage Licencing
Please click the headings below to learn more about licencing ET or one of the other Manchester Triage Systems products.
The key components are:- Obtaining a licence (details in this section)
- Accessing training for your instructors (see Booking a place on an ET instructor course below)
- Engaging with audit (see Audit and Accreditation section below)
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Licencing the use of MTS Clinical Risk Management Tools
The Manchester Triage System (MTS) is a series of clinical risk management tools used by clinicians worldwide to enable them to safely manage patient flow when clinical need far exceeds capacity. The following clinical risk management tools are available:- Emergency Triage: Emergency departments and Ambulance services
- Telephone Triage and Advice: Urgent care desks
- Prehospital Pathfinder: Ambulances
- SAFE pathways: Community-based clinicians
A formal governance structure for MTS ensures that training, audit and robust ongoing review is carried out routinely so that the tools stay safe, up-to-date and relevant to current practice.
The MTS tools are licenced to recognise the ownership of the intellectual property of MTS content and also to provide ongoing funding for the governance processes. The licencing agreement also provides a formal connection between the MTS and its end-users ensuring that end-users receive the correct training, engage in audit and are fully aware when updates are required.
The licencing process for MTS content is managed by Wiley on behalf of the Advanced Life Support Group and the Manchester Triage Group.
The first step is to register via our online portal to ensure that you understand the governance processes in terms of training, audit and licencing.
We have licencing options for:
- Software developers pre-populating with MTS content
- Software developers providing the framework for MTS but not pre-populating with MTS content
- Web-app developers pre-populating with MTS content
- End-users who purchase software pre-populated with MTS content
- End-users who purchase software with a framework but no MTS content embedded and then embed the MTS content in-house
- End-users who develop software in-house and integrate MTS content
- End-users who use paper-based systems to implement MTS content
The online portal is currently in beta format and if you have any feedback on its use, please email manchestertriage@alsg.org. The portal explains the rights and obligations of each option and the approach to and cost of licencing. Click here to start the process.
For end-users, one of the obligations is with regard to training and for Emergency Triage, Telephone Triage and Pathfinder an organisation is recognised as a Manchester Triage provider if it has instructors who have undertaken training with the Manchester Triage Group or with one of our International Reference Groups (see details in the instructor training section below)
Please read the liability statement here
Licencing the use of MTS Risk Management Tools
In recognition of the importance of safe decision-making in other settings, the Manchester Triage System (MTS) has been adapted with a Nursing and Residential Triage Tool (NaRT) and a Community Triage Tool (CoTT) for use in the following:
- Nursing and residential homes (NaRT)
- Out of hours and Telemedicine providers (CoTT)
- Telecare and Pendant providers (CoTT)
- First responder organisations (CoTT)
- Community assessment services (CoTT)
The principles of the Manchester Triage System are still followed with the use of the reductive methodology, however rather than choosing between 53 MTS presentational charts, these tools comprise just two charts; Illness and Injury.
Some discriminators and definitions have also been amended to enable both clinical and non-clinical staff in these settings to use the tools. Using these tools does not require a clinical decision to be made, rather it asks the person making the assessment to make their way through a list of presenting symptoms and, where the patient displays any of the symptoms on the list, the outcome should be followed.
Outcomes can be tailored to the availability of services in your area.
If you are interested in setting up any of these tools in a country, region or individual organisation, then the first step is to register via our online portal to ensure that you understand the governance processes in terms of training, audit and licensing.
Non-UK centres - book translation rights
If you are interested in translating the book for
use on local courses, please contact translationrights@wiley.com,
who will be able to check whether there is already a translation in your
language in the first instance. We prefer to license to local publishers to ensure that all translations are published on a proper legal footing and receive all due commercial support.
If you already have contacts with local publishers, we suggest you approach them in the first instance to find out if they might be interested in publishing a translation. If so, they would then need to contact Wiley at the email address above.We would ask that no translation work start before an Agreement is signed between Wiley and your selected local publisher.
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The Manchester Triage Accreditation Scheme
MTS Accreditation status will be awarded to a software company who:
- Provides a product that achieves the MTS IT specification
Implements updates to their software and cascades the updates to all users of the software within the timeframes outlined by MTS
- Informs MTS in a timely way when they implement software within a new organisation
- Pays the licencing fees due within the Wiley settlement dates
- Pays the review and approval fees due to either MTS or their designated International Lead within their specified settlement dates
- Certifies that no changes have been made to the product that was signed off
MTS Accreditation status will be awarded to an end user organisation who:
- Implements a software solution that achieves the MTS IT specification
- Implements updates to their software within the timeframes outlined by MTS
- Pays the licencing fees due within the Wiley settlement dates
- Where appropriate, pays the review and approval fees due to either MTS or their designated International Lead within their specified settlement dates
- Has two trained instructors who have completed training with the national MTS instructors who then provide training to all of their triage practitioners and log this training on the MTS platform
- Applies the MTS Triage regulations and carries out audit
- Submits the annual audit data and compliance information
- Certifies that no changes have been made to the product that was signed off
To apply for MTS Accreditation status, complete this application form online.
Accreditation, when awarded will be valid until an update is issued. At the point that a previous version of the tool expires (i.e. after three months for a patient safety update and six months for other updates), then organisations will be reminded and required to apply for re-accreditation.
Audit Tool
Audit is a key requirement for Organisations who implement Manchester Triage Tools. The standard for audit is 5 per practitioner twice per year, so 10 per year in total.
We are currently developing an online Audit Tool which will be integrated into this online platform to support your audit activities locally and also to provide benchmarking. We will inform all Triage instructors once this system is live.
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Emergency Triage Instructor Training
The aim of the course is to train key trainers from centres who wish to implement the Emergency Triage program. This course is aimed at senior Emergency Department nurses with a minimum of 2 years triage practice, and once completed will allow provider training to be cascaded in-house.
MTS Instructor Courses
The importance of implementing the triage methodology in a standard format cannot be stressed enough. Attendance at the national MTS instructor training days will ensure each centre is given appropriate direction and added information on dissemination of training and advice.
Please also note that it is important that you have the correct licencing in place before implementing triage within your organisation. To learn more about this, see Licencing section above.
Course Cost
The cost is £175 per person to attend.
During the course, you must have use of the most up to date 3rd Edition Emergency Triage manual. You will be sent instructions on how to obtain one when you enrol on a course.
Course Dates
Please note: Some courses are one full face to face day at ALSG Manchester and some courses are run using remote meeting platforms and split into two half days.
Please check here for current course dates.ET Instructor courses
The next set of MTS instructor course dates will be set in March, please keep checking the web site for details of the course dates.
Please note the courses will be pre-payment, please check with your organisation if they are able to provide a credit card for booking the course, alternatively staff can book the place and claim the funds back from the trust.
MTG do not hold a waiting list, if a delegate cancels, trusts will usually send another member of staff in their place.
Eligibility
The MTS Instructor Course is aimed at senior Emergency Department Nurses / Allied Health Professionals. The desired criteria for eligibility are:
· A minimum of two years Emergency / Urgent Care experience
· A good working knowledge of MTS and use of the system on a regular basis
· Senior staff who are in Practice Education roles
Once completed, you will be a verified MTS Instructor and this allows you to deliver Provider level training within your own clinical setting.
Important note about eligibility for Provider Course training
The Manchester Triage System (MTS) was developed solely for registered Health Care Professionals (HCPs) due to the clinical skills and knowledge, required to assess needs and plan care, when performing a triage assessment. MTG will not support organisations allowing the use of MTS by staff who are non-HCPs (staff below Band 5 UK or international equivalent). In any medical negligence proceedings where the court requests evidence, MTG will send a letter to this effect. click here for MTS professional statement 02/07/2021
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Emergency Triage Training Material
Emergency Triage includes online course material, face to face teaching and a printed manual. You'll find the introductory e-module below.
The full course includes modules on:- Introduction to Emergency Triage
- General and specific discriminators
- The triage event
- Pain
- Workshop 1
- Workshop 2
- Beyond triage
You can access the first e-module by clicking the link below.
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If you have any concerns about any of the discriminators and wish to report this issue to the Manchester Triage Advisory Groups, then please complete this e-form.
The Manchester Triage Advisory Group Chairs and Vice-Chairs meet on a quarterly basis.If you indicate on the form that the issue may be a patient safety concern, then the issue will be considered immediately on receipt by the Manchester Triage Board.
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The Manchester Triage Group (MTG) support for editions of Emergency Triage is detailed below. The current version of the text is Emergency Triage, Manchester Triage Group, 3rd edition ISBN: 978-1-118-2906-7 and the current version is 3.8 (updated November 2021).
The MTG is clear that a number of changes since 2015 are matters of Clinical Safety and that patients being triaged using previous editions may be at risk of mis-triage and may therefore have worse clinical outcomes.
MTG strongly advises all users not only to upgrade to the latest edition but also to ensure that any software provider is compliant with the critical update process that is now in existence.
MTG will not support users of previous versions/editions in court but will send a letter to the above effect to any medical negligence proceedings.
The Manchester Triage Group (MTG) will inform all licensees within 28 days about any patient safety updates.
For translated versions the International Reference Group (IRG) lead will be responsible for this notification.
It is the responsibility of the software company and their end users to ensure that their system is compliant with the updates.
Previous editions will not be supported after 3 months where there is a patient safety update and 6 months for general updates. -
The current version of Emergency Triage is 3.8 published in November 2021 and updated September 2024
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