Triage

  1. I am a "Shift Manager" on the weekends in a 30 bed ED. Our process flow is to bring all patients back to the ED if we have open beds with no triage done in our triage area. The only time we are to use the triage area is when we run out of beds. Anyone else doing this and if so, how is it working for you?
    As both primary nurse and shift manager, I have a problem with the patients being brought straight back with nothing but an eyeball assessment. I have had patients brought to me that came in by POV, with subdurals because of a head injury that had not been triaged.
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  2. 10 Comments

  3. by   traumaRUs
    Yes, that is what we do in the large ER where I worked: level one truama center, 65k visits/year. Pts were brought back and then a tech immediately went in, provided a gown and assist getting dressed, placed them on the monitor if needed and then the RN would come in. It is not necessary to do the full asessment immediately unless the pt condition warrants it. The RN initially does a set a vitals (if not already done by the tech) and then gathers general info such as chief complaint, history of present illness, allergies and pt meds. Then, from that info, the RN decides if the full assessment needs to be done immediately or if it can wait a few minutes.


    In our ER, in fact, the MD would see the pt when they had a chance too and that was often concurrently or even before the RN.
  4. by   TazziRN
    We do it slightly different: we triage in our triage room, then take the pt straight back if we have beds and do bedside registration.
  5. by   Larry77
    Quote from TazziRN
    We do it slightly different: we triage in our triage room, then take the pt straight back if we have beds and do bedside registration.
    This is what we do also, the RN triaging the patient usually assigns themselves the patient also. I don't like the idea of bringing the pt back without triaging because some of our rooms are more fit for say a pelvic or a cardiac pt...how would you know which room to place them if you don't at least get an idea of what the plan is?
  6. by   Altra
    Quote from Larry77
    I don't like the idea of bringing the pt back without triaging because some of our rooms are more fit for say a pelvic or a cardiac pt...how would you know which room to place them if you don't at least get an idea of what the plan is?
    Yep, this is the hangup of that approach ... the "R elbow pain" ends up in a fast track room and THEN it becomes apparent that a stroke workup is needed ... or the female sore throat announces that she also has vag discharge.

    I understand the wish to get patients seen immediately when there are empty beds, but there are drawbacks too.
  7. by   tweety55
    One of the problems that we have seen in multiple MVC's plus routine ambulance calls all comming in at once and then the triage/float nurse is filling all the beds at the same time. We see 30,000+ visits. We are only a level 3, but we see many MVC's, we are in a rural area at the crossroads of 3 major highways plus railway transit. My greatest fear is using one of our two trauma rooms for a migraine and then needing them in a hurry.
    In addition, we are adding an interventional cardiologist to staff and that will change the type of pts that we will be able to see, it's getting interesing
  8. by   TazziRN
    Quote from tweety55
    My greatest fear is using one of our two trauma rooms for a migraine and then needing them in a hurry.
    We have six beds, one is considered our critical bed. No matter how busy it gets, we try our best to keep that bed open in case we do get something. If we fill it and the others are full also, the first bed that gets emptied is kept open just in case.
  9. by   rjflyn
    We generally place the patient in a bed after they have been seen by the triage nurse first. The problem of bringing pts right back in my experence is that if you get a big rush of pt that exceeds the number of nursing assignments a nurse could potentially get two patients that at the time of presentation need one on one care and thats not possible if you are with someone else.

    We generally try to keep the assignements with an equal number of patients. Also we have for example 3 rooms that are set up for pelvic exams each on a seperate assignment. As it is we fill up pretty fast ie its full by noon or 1pm.

    RJ
  10. by   Pedi-ER-RN
    Our patients are seen initially by the triage nurse and usually sent back out to the waiting room to get a chart made. They only come straight back if their condition warrants it. I couldn't imagine taking pts straight back (would be a big HA where I work due to the registration process.).
  11. by   TazziRN
    Quote from Pedi-ER-RN
    Our patients are seen initially by the triage nurse and usually sent back out to the waiting room to get a chart made. They only come straight back if their condition warrants it. I couldn't imagine taking pts straight back (would be a big HA where I work due to the registration process.).
    We only started doing it this year, but it seems to be the new trend. The registration clerk brings a laptop to the bedside and registers.
  12. by   tweety55
    Quote from rjflyn
    We generally place the patient in a bed after they have been seen by the triage nurse first. The problem of bringing pts right back in my experence is that if you get a big rush of pt that exceeds the number of nursing assignments a nurse could potentially get two patients that at the time of presentation need one on one care and thats not possible if you are with someone else.

    We generally try to keep the assignements with an equal number of patients. Also we have for example 3 rooms that are set up for pelvic exams each on a seperate assignment. As it is we fill up pretty fast ie its full by noon or 1pm.

    RJ
    Our process now is that as soon as they hit the door, registration clerks are on our radios to let us know that there is a pt. The triage nurse, who also is a float nurse, is expected to stop what they are doing, go directly to the front, get the pt, bring them back. Initial registration is done at the bedside and then full registration is completed when the pt has seen a physician, or FNP. Several times, our triage/float person has brought someone back and because the primary nurse was unavailabe, started CP or stroke protocols on that pt. Now, they have to drop everything to "eyeball the pt" and initiate the triage time on the computers. We are expected to have triage times under 10 minutes at all times, no matter what the circumstances. Many times, our primary nurses will get hit with up to 3 new pts at once.

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