how to manage the waiting room?

mamalle · Apr 23, 2007

we pull them back into triage due to HIPPA. I feel bad though since when they hear their name- they think its to be called back- not just back to triage to be reassessed.

PedsER-RN, BSN, RN · Apr 25, 2007

we're supposed to be doing this, too. the only problem is, management doesn't seem to acknowledge that if you're in triage on a busy night (and our dept has 1 triage nurse), there's abosolutely no way you can keep up with your triage list and still find time to do hourly, or even q2-3h vitals. it just isn't going to happen, unless they allow for more staff, which they won't. what i try to do is with the ones that are semi-sick/injured, but aren't acute enough to be bumped, i'll warn them that there's going to be a wait (and probably a long one), but if anything changes while they're waiting (ex: loc in a head injury pt), let me know. i'll then do a quick assessment, and if warranted, they'll get bumped. if i do get a break, i'll go around and recheck vs and do a focused reassessment.

RunnerRN, BSN, RN · Apr 26, 2007

Here's my method on this....I take the time the I have the patient in my triage booth as a chance to update them on the procedure (I've found that a lot of people just dont' get the processes in the ER). Explain the length of time that is our longest wait at that time, and explain that if their sxs worsen, they need to let us know. I also explain that in about an hour or two, if they are still waiting in the WR, they will be recalled to the triage booth so we can check their BP again and make sure nothing has changed. This lets them know that we're still thinking of them even though they're stuck in the WR for hours at a time.

Now the logistics of actually getting someone back into the triage booth when you're backed up like most of us usually are.....we've scheduled an extra RN and tech to triage when we're most busy, and pull them into our "mini room". It seems to work pretty well. No we don't ALWAYS get our second sets of VS, but try really hard to get them on medical c/o, abd pn, chest pain, etc.

teeituptom, BSN, RN · Apr 27, 2007

When people ask about the wait I usually say "the person that has been waiting the longest has been here for xxx hours." They may feel grateful it's not them, or give up and go home at that point.

And I also tell them everytime they come and ask me I mark their charts for a 15 minute penalty wait for interrupting me.

gonzo1, ASN, RN · Apr 27, 2007

You crack me up Tom. I don't think I could get away with that being a petite little blond that looks like a librarian, or so I'm told. I did however use the phrase "What is your emergency today" about 85 percent of the time the last time I did triage. It worked okay I quess. Of course, it completely flew over the heads of the ones that it was really aimed at.

chip193 · Apr 28, 2007

During days and evenings, we have two triage nurses and a "Triage Liason". Vital signs are done q1hr and work-ups are started (bloods, xrays, even the occasion CT) when things are backed up.

At night, it's just a single nurse. And we still manage to get the work-ups done. The vitals are closer to a qwhenever I can, but by getting the work-ups done, the stay inside the department is faster and the beds turn faster.

Chip

ParrotHeadRN · Apr 29, 2007

I work in a small 13 bed ED and at night we have 2 nurses. When we are busy, we are unable to have an appointed triage nurse, much less spare someone to do triage rounds. Whoever is not busiest at the moment will just run out to triage when the bell rings. It would be awesome if we had a nurse simply for triage at night. However, even during the day the triage nurse ends up helping out in the back when it's crazy. Which sort of defeats the purpose of a triage nurse. :uhoh3:

teeituptom, BSN, RN · Apr 30, 2007

You crack me up Tom. I don't think I could get away with that being a petite little blond that looks like a librarian, or so I'm told. I did however use the phrase "What is your emergency today" about 85 percent of the time the last time I did triage. It worked okay I quess. Of course, it completely flew over the heads of the ones that it was really aimed at.

Im old enuff

Im ugly enuff

that I cant be manipulated

RNinED · May 7, 2007

A little education goes a long way. The patients I explain it all to (possible wait, recheck vs, more serious c/o first...) seem to deal with the ED process much better. Can't a ED tech (CNA or EMT-1) do repeat vs and report abnormals to the triage RN so pt can then be reassessed? I work in Ca. in a 7 bed ED that is often stretched to overflowing 10 bed/chairs. On the busiest days we see 60 pts in 24hrs. Average is 35-45. I think we are well staffed with 3 bedside nurses,a triage nurse and a tech. but We still haven't developed a plan for rechecking VS if pt is out in WR >2 hrs. What we have accomplished is an average ED visit of less than 4 hours from arrival.

ICU_floater · May 7, 2007

Ours has all yellows (near emergents ie. cp with normal vs) with a protocol from triage, to RN who does ekg, labs, then a cxr. if ekg is abnormal, brought to back. if good, they sit and wait for labs, all yellows have a similar protocol, so labs are cooking while they're waiting. Labs are back in an hour, so you have an hour to prioritize the ones your worried about. The greens or blues (my toe is broken) are then re-rotated through... sorry for the wait, it looks like 4 more hours, let me recheck your vs, do you want a blanket... and all NEW triage non yellow complaints are bumped untill you re-assess. We stagger, take a abd. pain who's yapping on the phone for triage then a reassess, a non exanginating lac then a reassess.

We'll have over 100 at a time in the er with 2 triage rn's and one running ekg and labs on a bad night with an inside main ratio of 10 plus to 1 rn:uhoh3:

10MG-IV · Dec 30, 2007

the people aren't here ( in the waiting room) to see a nurse, they want to see a DOCTOR

GET THE SYSTEM FIXED, GET THE ADMINISTRATION TO F*#*$) FIX IT. Then, we won't have all the angst.

10MG-IV · Dec 30, 2007

the people aren't here ( in the waiting room) to see a nurse, they want to see a DOCTOR D O C T O R, then they have to see us because the doctor doesn't know how to do any of what he just wrote to do. Anyway,

GET THE SYSTEM FIXED,

Get the rooms open quicker, don't do 5 hour work ups in the ER, admit orders written, and get the patient out of the ER to another area ASAP to free up the room. There should be a 60 min time limit for each patient in the ER. once 60 min is up they have to move out. no questions asked out move to another area for follow up, holding area , OP clinic what ever. send them around the corner for another MD to view the labs xrays and diagnose and write the scrips keep them moving. GET THE ADMINISTRATION TO F*#*$) FIX IT. Then, we won't have all the angst.