Lining and labing in the waiting room

psu_213, BSN, RN · Mar 1, 2012

I have heard of our ER drawing labs on waiting room pt's. I really don't think lining them a such a good idea--to put an IV in them and then have them in a place where they could so easily slip away (then again, it could be argued that even if you line them in a tx room, they can still leave).

In my mind, if they are so sick they need an IV/fluids/other meds that badly, then they will be brought back from the waiting room to at least a hallway.

alimill · Mar 5, 2012

We have recently went to Epic at my hospital and there are integrated care sets that the physicians have put together. We care encouraged to do it, especially when there are several hour waits, however, there are people that say "what if they are a left without being seen pt and they get charged for running lab and other diagnostics?" so....i'm on the fence about this subject.

the1anonlycarol · Mar 12, 2012

Where I work, we sometimes have 5-6 hour waits (terrible I know). Our WR patients are never allowed to have lines and I can't think of a time I've ever medicated one. When they are first triaged, we sometimes have a midlevel provider that listens in, does a quick assessment, and puts in some basic orders. For example, for a ? appy, they can order a CT or bloodwork to start. Phlebotomy pulls the patients from the WR to separate chairs, draws, and then returns them to the WR. We also have a sub- WR, five rooms w/ stretchers. It is used for those patients that need to go back first or just aren't appropriate for the main WR. Those patients are allowed to have peripheral IVs and typically have medications and more orders entered by the midlevel provider.

the1anonlycarol · Mar 12, 2012

That is a major concern for us as well. If our WR patients see a midlevel provider when they are first triaged and have orders entered (labs, X-ray, etc) and end up leaving then they are marked as ELOPED and the visit is chargeable. If they don't see a midlevel provider, and only see the triage nurse and end up leaving then they are a LWBS and the visit is not chargeable. That means that when we collect a urine sample from them and do a dip and pregnancy test, we have to eat the cost if they end up as LWBS. I could be wrong, but I think this is how it works in our ED.

Hagabel · Mar 12, 2012

The hospital I just left last yr in the States was encouraging us to lab/line in the wr if we had time but I never had time(only 1 triage nurse) and was uncomfortable with that so I would have techs draw bloods and only place IVs on really sick pts for whom I am calling for a bed asap. They introduced a disclaimer form that the pts signed if we put a line in and removed responsiblity from the hospital if they left with it.

Here in NZ large proportion of our pts get lines/labs in w room and nothing to sign. Apperas to be a very low portion of pts with IVDA issues (only seen 1 so far) and those pts don't get one.

Also send pts home with 3 day IV and cellulitis protocol as well.

Interesting the difference practices.

hollysunshine · May 29, 2012

We have triage protocols that are complaint driven. Anyone not being seen for crisis or urgent care gets lined and labbed. We can give IV/PO narcs, antiemetics, and fluids. I've really only given Zofran. Makes me too nervous to give IV Dilaudid to someone that I can't keep my eye on. Our triage area is fairly far removed from the waiting area and behind several closed doors. I've given Percs to some orthopedic injuries that we couldn't get back right away. The triage protocols were designed by our group of docs.

csriver · Sep 29, 2012

My ER has a provider in triage who sees the patient and assesses them we draw simple labs we have 2 chairs behind triage that recline. For EKG's and potential IV infusion and maybe medication. but once they get an IV we do not send them back to the waiting room. if the patient wants to leave we pull out the IV.

jenfromjersey · Oct 1, 2012

We have a midlevel provider in triage every day from 11am until 9pm. After a quick triage (vitals, brief complaint and ESI level only) they are seen by the midlevel (in separate area) and orders placed in computer. After that, they are called into a separate room where there is always a triage tech from 11am until 11pm and if staffing allows, a protocol nurse. The nurse is responsible for placing lines, medicating, and completing the medical/surgical history, inputting medication lists and allergies into computer. If only a tech, then labs only are drawn and EKGs if ordered. There is an exam table in there and a dynamap for vitals. We do our reassessments in there when there is a long wait. Also, if the midlevel is discharging from triage then exams are done in there if required to be evaluated by a physician.

We do not give IV narcotics in waiting room. We will give an occasional Percocet. We routinely lock and lab and give IV Zofran and fluids for gastroenteritis type complaints. We also drink patients for belly CTs out there and they need the IV for the contrast injection they get in CT scan dept. We also give tylenol/motrin out there for fevers. We often have 3+ hour waits so getting all of that accomplished in the waiting room may seem like a liability to some but in reality, it is less of a liability than sitting in waiting room for 3 hours with NOTHING done. Once labs are back they can be reviewed and someone who is walking and talking with normal vitals may have a potassium of 2.5 or a hemoglobin of 6 identified. When there are 20 people in the waiting room who are all level 3, it really helps to prioritize who needs to come back first. Usually the loudest complainers are the ones who have nothing going on and they end up being pushed ahead of the quieter ones who end up being sicker in the long run. I find it extremely helpful when I receive a patient from the waiting room on a hellacious day who has already been locked and labbed. The ER doc then only needs to review what has already been done and then fine tune the treatment plan. Additional lab studies can be added to the blood already in the lab. It speeds up the dispo time once they get to the back. I love it.

ecerrn · Oct 8, 2012

Sure sure, line and labs, follow the protocols for additional tests...however other than acetaminophen, drugs like that, are about all I'd ever give out in triage. The majority of people seeking drugs have no problems (usually) finding their own veins, and if they are there just to get a line put in, it will be so obvious to you. You can also educate the pt on why you are expediting the lab work and placing a line, and if they want to leave please have it taken out. Document this education. If tis pt really really needs meds, the really really need to be taken back.