Medical Screening Exam at triage by RN

The radiologist reads the Xray. We wait for the dictated report. Doesn't take long at our facility as it is not a huge ER.

Medical Screening exams are outside of the RN scope of practice and only NP or PAs if the hospital Medical bylaws agree. You have to ask yourself what will be needed to completely medically screen a patient? Can you order a CAT scan on your license only? No so if someone comes in with the "worst headache" a medical screen would require a CT.. that should answer your MSE questions.. NO MSE by RNS . And EMTALA does not have within its scope the permission to perform MSE by an RN.. the State board does.. good to be knowledgeable of your state board and healthsystem policies as well as ENA ..

It obviously depends on where one works. The triage protocols are very extensive where I work. I have ordered several CAT scans on patients from triage. One example, would be the patient who had a headache located directly behind one eye (pain began 5 days ago). Their were a couple of other s/s too, but otherwise negative on the cincinatti stroke scale. Lobby wait times were crazy that night (even for ESI II's), and I just had that feeling for this patient, something was not right? Within 45 minutes of this patients registration time, I was reading the radiologists interpretated results of glioblastoma (sad). I am not sure by what you ment of ordering these scans on your license "only", but yes, we'll order practically any test we deem necessary from triage (even if that means placing an IV just prior to CT transport, etc...)

I am not too sure on the whole MSE being done by the triage RN though? That just seems like a bit to much for us to shoulder - having to triage, screen, order the appropriate tests, and discharge certain patients without them ever having been seen by an MD... That does not sit well with me.

Ordering CT's is outside the realm of the MSE. The MSE is to establish whether an emergency condition exists. It's not part of Triage. IF the patient needs a CT then they are an ED patient and can't be turfed anywhere else.

And as others have posted, each state is different as well as each hospital.

WIth the current trend of MD or Midlevel in triage/RME/ whatever you want to call it, there is almost no need to RN's to be doing MSe's.