Clinical Tools

Patient Pathway

The National Emergency Medicine Programme (EMP) recommended that the Manchester Triage System (MTS) (Mackway-Jones et al, 2006) should be the triage system used for all new adult (16 years and over) patients presenting to Emergency Departments. This recommendation was further endorsed when the EMP was tasked by the Health Service Executive (HSE) to support implementation of the Report of the investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH) for patients who require acute admission, Health Information and Quality Authority, (HIQA Tallaght Report, 2012). This Report stated that “The Manchester Triage System must be implemented, managed and periodically evaluated to ensure it is being applied effectively in all hospitals”.

The EMP Emergency Nursing Interest Group (ENIG) was tasked with addressing these components of the programme and report with full support and guidance of the EMP Working Group. ENIG approved the engagement of the MTS Group for a national training strategy and agreed that the MTS Audit Tool should be used to audit triage practice.
Each Emergency Department (ED) is advised to refer to the EMP clinical guidance on “Audit of Emergency Department Triage”.


Since July 2014 all Emergency Departments in Ireland have a Manchester Triage Trainer. All Emergency Departments must be using the 3rd Edition of the Manchester Triage System (MTS)

The Clinical Decision Unit (CDU) is an inpatient facility adjacent to the Emergency Department (ED) managed by Consultants in Emergency Medicine (EM).1 CDUs may also include Chest Pain Assessment Units and may have been previously termed ED Observation Wards or Short Stay Units in some hospitals. The fundamental purpose of a CDU is to make safe, timely and economical clinical decisions on patients who present to the ED with specific emergency conditions whose length of stay is likely to be no longer than 6-24 hours duration.


A patient admitted to a CDU must have a specified suspected condition that comes under a defined evidence-based clinical pathway or Standard Operating Procedure (SOP). The conditions managed in a CDU may be obtained from the list of conditions outlined in this report that have an international evidence-based SOP but this list is not exhaustive. The list of conditions managed in any CDU can vary from one ED to another as it will be influenced by local needs, the physical size of the CDU and local expertise. Patients are usually managed by means of a specific patient-care pathway from ED assessment through to discharge within 24 hours.”

A number of suction-based airway clearance devices for the treatment of choking are available in Ireland. The Emergency Medicine Programme and the Irish Association of Emergency Medicine does not currently support their use due to the lack of research on the safety or effectiveness of these devices. Similar to the Resuscitation Council in the UK, we have concerns that the use of these devices could delay established treatments for choking.


Parents with young children are advised to familiarise themselves with first aid techniques and follow the HSE guidelines on choking for babies under 1 and children aged 1 year or older.  These steps are easy to learn and can be initiated promptly and effectively without the requirement for equipment. 


For adults, if the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. Where choking is severe back blows and abdominal thrusts may be needed.


Appropriately trained healthcare professionals use advanced techniques such as suction or laryngoscopy and forceps for the removal of foreign body airway obstructions.