Need help with Emergency Triage

  1. I am currently in my last semester of RN school and my class is having to do presentations. My part is on Emergency Triage and prioritization of care. I was wondering if anyone that works in the ER or is a triage nurse would let me know how you decide on what category your patient goes in when they present to the ER. Basically what criteria they have to meet whether you send them to fast trak if available, Acute, etc... Any help would be greatly appreciated. Thanks.

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    Tiffany D. Garren
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  2. 11 Comments

  3. by   LisaPRN
    Basically its split up into 3 categories. Category 1 patient is anyone who cannot wait for any lenght of time. Their complaint needs immediate intervention. Category 2 is anyone that has a complaint that can wait a couple hours and will be ok waiting. and Category 3 is anyone who could wait till hell freezes over and would be just fine. Sorry, I work a lot of triage. Of course as the previous person stated nursing intuition and experience plays a large role in the nurses decision making. Hope that helps a bit.
  4. by   madwaeit
    the triage used in my department in Elgin Scotland is the Manchester Triage System which works like all others in a pyramid like fashion, that is with the most needy on top cascading down to least urgent.

    The top category has obviously no waiting time second has 10 minutes third has one hour forth has two hours and last has four hours.
  5. by   ednurse17
    I work in an 18-bed ER in North Carolina. We use the 5 level triage system. Resuscitative to Non Urgent. Basically, classifications goes like this, non emergent is for anything that doesn't require an xray or lab test. Examples would be toothache, chronic back pain, chronic headaches, ear aches, etc. Semi urgent would be a pregnancy test, UA, xray (meaning only one test performed). The next level is urgent.... meaning more than one test will be perfomed, next is emergent, which means of course, a whole bunch of stuff will be done and the level of care is upped, and last but not least resuscitative - we all know what that means!!!! It works out well. The semi urgents and non urgents go to minor care when its opened, the rest go to major care. Hope this helps. Triage nursing comes with experience. We don't let new nurses do triage until they've been in ER for a year. Gets some critical thinking skills under their belt before being appointed "gate-keeper". One may come in that's a chronic headache, but you've got to know the questions to ask to see if anything about this headache is new. Same goes with chest pain. Not all chest pains are heart related. Goes back to asking the right questions, that you acquire with experience.
  6. by   Pedi-ER-RN
    We currently use a 3 tier category system: 1, 2, and 3

    Cat 1 means life/limb could potentially be lost if immediate intervention is not rec'd, these pts have no wt time.

    Cat 2 is urgent, should be seen within 2 hrs

    Cat 3 is non-urgent, should be seen within 4 hrs, but that usually doesn't happen because cat 1 and 2 patients come in and "bump" these pts. Also, if it is in "normal" business hrs M-F and the pts PCP will accept them, these can be triaged out to their doctors office for eval and treatment.

    We really could benefit from a system with more than 3 categories.

    Hope this helps some
  7. by   ednurse17
    We used to use the 3 level system. Found out that the 5 level works out much better. There is a consultant who is a nurse that holds "triage first" meetings nationwide. For the life of me, I can't think of his name at the moment. He's great!!!
  8. by   ednurse17
    His name is Bo. Funny guy!!! Classes were excellent!!!!! Go to triagefirst.com
  9. by   Pedi-ER-RN
    Thanks for the website, I will check it out. I think 5 levels would be great to have. Doubt our hospital will change since we are part of a system and everyone in the system uses the 3 category method.
  10. by   MajorDomo
    We use the five level ESI system, recommended by the ENA. All the material and algorythms are free at this site: http://www.ahrq.gov/research/esi/esi1.htm
    The info basically covers the basics of triage.
    MajorDomo
  11. by   NYCRN16
    We use a 5 level triage system. I will provide you examples of patients that I would categorize into each level to give you an idea, but feel free to PM me if you have any questions.

    Level 1: Patients in cardiac arrest, unresponsive/comatose, severe trauma, patients who are not breathing or who are intubated upon arrival.

    Level 2: Patients with chest pain who are high risk (elderly, have significant hx such as CAD or diabetes or MI in past), real resp distress, seizures, drug overdose and is responsive, GI bleeders

    Level 3: Most abdominal pains, vaginal bleeders (unless severely hemmoraging), back pain, nausea and vomiting, severe diarrhea with no blood in stool, low risk chest pains, stable asthmatics, psychiatric complaints

    Level 4: Simple lacerations, patients who are otherwise healthy with cold/flu s/s, simple injuries such as twisted ankles with no severe swelling, ecchymosis or signs of compound fracture or compartment syndrome

    Level 5: Suture/staple removal, medication refill, social service issues
  12. by   ClaireMacl
    Our level 5 is problems over one week old, we use manchester triage. We also added a 6, which is see and treat, such as dressings, suture removal, nurse practitioner review etc.

    Can't wait until our minor injuries unit opens later this year, we currently lump them in with all the emergencies and that gets their blood pressure up Hopefully it'll be going in June and we can refer all morning after pills, minor lacerations etc there!
  13. by   TinyNurse
    I love the 5 level triage system, but I think lisaprn's 3 level system is much better!

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