triage

Specialties Emergency

Published

We've just been informed by our new er manager (an rn), that our LWBS numbers are too high. (Left Without Being Seen). Meaning the patients are not wanting to wait (sometimes 2-3 hours, not bad considering county hospital sometimes has 18 hr waits!), or they decided they aren't really that sick, or have gotten an appt with their dr...........whatever the reason. So she has put out a memo stating that "this WILL change!" We (the triage nurse), are to "go out in the lobby and check on patients" ............and do what, we wonder? Chain them to the chairs so they won't leave???? She then proceeds to write that "if I notice trends among certain nurses, these will be documented, and there will be Verbal Warnings!" (Like what comes after verbal warnings?) Some of our nurses seem to be stuck at triage every shift. Some, like myself, hardly ever do triage. I don't know why. How the hell are we supposed to keep people from leaving the waiting room? :angryfire We are all somewhat pi##ed off about this. I mean, if people are waiting........that means that we are FULL! and FULL means that sometimes we have people sitting in the hall in chairs, not even in a bed (because they are all FULL!) Good grief :rolleyes:

We already have a policy implemented that we are to do vitals every 2 hours, on every patient (minimum) whether they are in the lobby or in the er. When someone leaves with out being seen, we are now to write up an incident report.......believe it or not....... with the reason they left. Hello, they don't always tell us they are leaving. Besides, if it is so busy, that I cannot get people into the back........how much time do you think I have to write up incident reports???? Aargh :angryfire

Just a long vent...........anybody else EVER had this happen? I mean, jeez, if they are well enough to leave, they probably didn't need to be in the er in the first place. and if they were really, really ill, the triage nurse would've found SOMEPLACE to put them in the er. Not back in the waiting room.

good lord. :crying2:

Specializes in Emergency Room.

still wondering, besides the one post, what the percentages are at other er's with the people who leave either before or after triage. Like I was sayingl, she says we are at about 10%. I have absolutely no idea where we stand compared to other er's.

thanks

Specializes in Emergency Room.

in other words, looking for a little ammo here.............. :p

our 55-bed er sees ~ 85,000 pts per year, and climing as most of you. our lwt (left w/o treatment) % is ~

Carotid

Specializes in ER, ICU, L&D, OR.

we were so busy one night. I even had to make my wife wait 3 hours out front before she got back. Couldnt be helped. She still hasnt forgiven me and thats been 3 yrs now.

Specializes in Nephrology, Cardiology, ER, ICU.

Although dumb - its being mandated by JCAHO and other inspection organizations. We went through it a few months ago. We take vitals q1hr on everyone. One thing we did that helped decrease the number of left w/o treatment was that our case managers now talk with patients that are waiting to ensure they have the right resources and really need to be seen in the ER. So...this has helped. Good luck...how about asking the unit manager where this edict came from and what standard must now be fulfilled?

TraumaRUs said,

"our case managers now talk with patients that are waiting to ensure they have the right resources and really need to be seen in the ER."

if they really don't need to be seen in the ed, what do they (case managers) do? is that decision based on "right resources", like having a pmd.?

Carotid

Specializes in Emergency Room.

I'm sure the memo started with the head honcho's. $$$$$$$$$$$$$$..... Our nurse manager seems to be management-pleaser, not stand-up-for-your nurses type.

Specializes in ER, ICU, L&D, OR.
I'm sure the memo started with the head honcho's. $$$$$$$$$$$$$$..... Our nurse manager seems to be management-pleaser, not stand-up-for-your nurses type.

Having been management in the past

if you want to stay there

you have to be

Now Im just plain old staffing and I love it

Maybe I'm out of line here, but I would think the LWB's (left without BREATHING) ought to be the concern.

Maybe at initial triage, one of your questions could be, "no, do you really need to be here?" Then if they say something like, well, no, you can send them on home with a hug????

If people aren't dying, if they are well enough to get frustrated because they aren't getting seen fast enough to get to work or home to the TV show, or whatever, well?

Sounds like the mgr is a dingbat (no offense Edith!)

JMHO

I don't know numbers but our LWBS pts are pretty low. We, too, have to fill out occurance reports each time. AMAs, too.

We see about 35,000 pts/yearly in our ER.

We have 20 beds-6 of them in our fast track.

We have a 24 hr charge nurse, 20 hr triage RN, 4 RNs unitl midnoc in the main ED then drop 1 at midnoc and 1 at 0300, and 1 RN in fast track unitl 1600 then 2 RNs until midnoc there. We also have NTs (mostly EMT/medics)-1 in triage 24 hours, 2 in the main ED except from 10-1600, then only 1, and 1 in the fast track.

Our NTs also start IVs, draw blood, do ECGs, post-molds, dressings, foleys, etc. They are a HUGE help in our ED!

We have PAs in fast track from 0900-0100.

We have 1 doc in the main ER from 23-1000 then we go up to 2. Our docs do 8 or 10 hour shifts...so at their shift change, when there are 3 docs in the ED, if we are hitting it usually one of them stays so we have 3 docs for awhile.

Our wait times are usually 1-2 hours...but when we start hitting it the waits are more like 3-4 hours. But our pt population is so used to not having to wait for long..they are FURIOUS when they have to. I would love to have this website up for people to see that waiting is EVERYWHERE!!! You guys really have a POLICY to re-check VS every 1 or 2 hours...on EVERYONE?!! Man...we don't ever put times into our policies...miss one and you have got nothing to stand on if someone decides to sue over a "bad outcome".

We use the ESI 5-tier triage system...works GREAT! We are able to see not only how many are waiting but what acuity they are. It also works well with our administration (who are still learning it) to be able to tell pretty close what potential admits we have.

As for your manager...give him/her a stethoscope and tell him/her to get out there and help if she/he wants thing to change. Nothing like a little finger-pointing to rile up your staff!!

:angryfire

p.s. I believe our left without being seen percentage is 10%.

I'm not sure how to address the AMA problem yet. I'm positive that it is a problem and needs to be addressed by management more so than it has been historically - 10% is way to much. That's just bad business. How many of those AMA's go home without seeking treatment elsewhere and end up dead on the couch? Think about it. How long would you own a vehicle that one out of every ten times you went outside in the morning to go to work just to get into it and find out it won't start? Seriously, erdiane your numbers put you at approximately 14 walk outs everyday! It's only about $6,000,000.00 that's right 6 million a year in revenue they're just flushing down the toilet. You need to tell your nurse manager, Diane that they need to come up with a better keep these people other than taking their VS every two hours. When you can show those kinds of numbers as losses you can really use some creative forces to justify promote your ER.

Specializes in ER, ICU, L&D, OR.

what they need to realize is most ER account for about 30% of their admissions

therefore if 10 a day elope or ama then your losing 3 more admisssions, That accounts for even more lost revenue

Even jewelry stores have whats called a loss leader

something that is on sale that they take a loss on but gets you in the store to buy other stuff while your there

Need to male ER pts happy at all times thats your loss leader in the hospital

It will pay off.

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