Quote from TaraER-RN
Hello....I am looking for ideas from people who work in busy ER's (greater than 130 coming in daily) on how you manage your triage flow. We just started using ESI (emergency severity index) and its important to us to have a nurse be one of the first points of contact to make sure the patient is safe to take a seat, "ok to wait", for their medical screening exam and not a priority 1 or 2 that needs to be taken immediately back. We are an HMO that uses name and medical record numbers to put people into our computer to track everything including the initial triage and MSE. But I am finding our flow just doesn't seem to be working, especially when it is busy. We have only 1 triage nurse and 1 MSE nurse, so its getting pretty backed up and people are waiting longer to get their MSE (and the patients and us are not use to the longer waits---so we are having a lot of complaints!) also with our flow we have a lot of bouncing around, and the patients getting up/down a lot to see the triage nurse, then to see the MSE nurse and then to see the receptionist and then again to go to the back. SO I thought I would like to see if anyone out there uses a computer system like this and is using ESI and how you guys manage the busy patient flow....thanks in advance!
I'd like to help but I don't quite understand how your flow is working now or was working before. What is the function of your MSE nurse? (not familiar w/that term) Why is the utilization of the ESI making for longer waits?
Our flow goes something like this: pt. presents to waiting room, gives name, DOB & chief complaint to registration clerk. We have one triage nurse. Depending on pt.'s complaint, they might continue with the registration clerk & give demographic & insurance data, or the triage nurse might call them in immediately (if it's a perfect world and there aren't 10 other people to be triaged, lol ...). Pt. is triaged & assigned an ESI number. It's the responsibility of the triage nurse to continuously "eyeball" each new pt., even if their chief complaint listed is something minor, and assess whether to stop everything & get that person back immediately if it's warranted.
ESI "4"s and "5"s get directed to the urgent care side of the ER, as well as "3"s that won't require cardiac monitoring.
Our volume is such that ESI "3"s do frequently have to wait during the busier times of the day/night.
Hope this helps?