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Acuity: How sharp are we?

It appears that we have insidiously fallen foul to yet another ‘northern Americanization’ of the medical language. In reference to emergency medicine, what does ‘acuity’ mean? The word is almost invariably used in conjunction with triage. The Australasian College for Emergency Medicine uses the term ‘treatment acuity’ in their Australasian Triage Scale Policy/Guideline, but do not define the term anywhere in their college website. A similar situation exists in the UK where the British Association for Emergency Medicine (BAEM) uses the word in their ‘Way Ahead’ 2005 document which also fails to define the term on the BAEM or College of Emergency Medicine site. The American College of Emergency Physicians does not use the term and appears to struggle with the national standardization of triage. The Canadian Association of Emergency Physicians uses the term most widely and it is entrenched in their literature. A search through the standard emergency medicine texts reveals the word mentioned once in two texts, yet without explanation of the word. Searching the standard dictionaries for North America, UK and Australasia reveals the definitions that relate to sharpness/acuteness/keenness of perception or of the senses. It is derived from the Latin word ‘acuere’ which means to sharpen. The standard medical dictionaries also relate the word to vision or hearing, but not to triage or emergency work. A search through the medical literature databases of Medline, Embase, CINAHL and the British Nursing Index cross-referencing the word ‘acuity’ to ‘triage’, ‘accident and emergency department’, ‘AED’, ‘emergency’ or ‘emergency department’ uncovered 260 references of possible relevance. The oldest reference in the literature that I could find relating acuity to triage and emergency medicine was from 1984. The word, ‘acuity’, appears to have been first used in the USA, and thereafter it mainly appears in nursing literature especially that originating in North America. Only one text found during my search attempts to give a definition to the word. It defines it as: ‘Acuteness, as of an illness. The term is used a great deal in reference to nursing needs and demands for other healthcare resources: the greater the acuity, the more nursing care or other services are needed.’ Acuity is mentioned in terms of resources and managing the acute patient workload. It therefore requires a formal definition. To create the word, ‘acuity’, to replace the word ‘acuteness’ is poor or sloppy use of the English language. It is like creating the word ‘obligated’ to replace the word ‘obliged’. Slang is defined as ‘words, phrases, and uses that are regarded as very informal and often restricted to special contexts or peculiar to a specified profession’. Jargon is defined as ‘words or expressions used by a particular group or profession’. Alternative definitions include ‘barbarous or debased language’ or even ‘gibberish’. Whether ‘slang’ or ‘jargon’, I will leave it to my learned colleagues of the international emergency fraternity to define what this word means, so that a clear common understanding exists when communicating with other emergency medical workers. Maybe then I can negotiate greater resources if I have a workload of increasing ‘acuity’.