We use 5 tier system, however, you rarely see 4 and 5 used. Even our Fast track gets 3. The reality is that anyone who appears not to need a workup is going to fast track.
Cp, and sob, are the first ones in regardless, the poor renal colics 10/10 and NV seem to languish in wait room. Our triage nurses will triage for all areas, until we have two nurses in Fast track, usually at 11am. Nurses do bedside triage for patients brought in by ambulance who are emergent. Our general triage will also do pediatrics until a third nurse reports to peds ER.
Triage is responsible for ekg of cp, sometimes ordering of xrays for obvious frx if pt going to ft, initial first aid, tylenol or motrin for pain or fever, ice packs, and even initiating cardiac workups. In addition, we too are to reassess after two hours.
New nurses must wait one year before a triage class, then an 8 hour class is held to go over acuity levels and triage procedure.
Our ER is 55+ bed (hallway if we need adds another15-20), we see over 75k patients annually. This past Monday we saw 329 patients in 12 hours-It was nuts!! I think we'll be closer to 100k this year!