triage - page 4

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... Read More

  1. by   teeituptom
    sounds normal enough to me
    and My ER is about 40 beds including 9 fast ones

    Good luck meeting with admin I always find those meetings informative and they usually bring food with lois of sugar to defuse you

    dont eat the sugar, Sugar
  2. by   Calfax
    Quote from LIVANDLUVER
    erdiane

    The small community hospital I work in see's 40,000 people per year. We have the largest influx of ambulances in northern california,700 ambulances a month. Recently our Emergency Department decided to do away with "triage" they now call it Rapid Medical Evaluation. This new system will have all walk in patient seen initially by a PA within thirty minutes of arrival. Once seen the PA will get labs, xrays ordered and immediatly treat those who would normally be seen in the fast track type system. Also included in this RME team will be a RN, LVN, and ER tech. This is supposed to decrease the wait times (average 2-3hours) and improve on the 9% of our patients who leave without being seen. This system will start March 5th. I am curious to see how effective it is, sound promising but well have to wait and see. I will post and let you know howi t goes in couple of weeks; and possibly you can make some suggestions in your department.

    livandluver

    How's this system working out for you? I'm a Navy ER nurse and this is similar to what we do in the military. As RN's, we have a very free hand as to what we can do at triage and I send people for all kinds of x-rays, order labs, give meds, fluids, etc before they ever reach a physician. This is not because I'm an old, salty RN....but because resources are so scarce, that it's necessary to do this, just to get ppl seen. However, we do have a series of guidelines/protocols that govern what we can do. But it's not uncommon, on busy nights, for me to splint fractures, suture marines, and discharge patients from triage, with a walkie-talkie consult from the doc.

    When I was a civilian, at the facility I worked at, we had to wait for a physician to eval pt's before we could do a lot of things....and waits were hours. On the military side....waits are still hours but I can do things while they wait.

    Also because I am military, we have an extensive series of clinics that I can book appts for patients to go to, rather than be seen in the ER. While this is nice, not every patient should go to a clinic.....and I often run into problems (re:shouting matches, arguments) with physicians over seeing or turfing patients. This presents enormous liability with EMTALA issues as well.
    Could this work in a civilian setting, too? Does anyone have a system like this at all?

    What's the hardest part about learning triage is just experience....you shouldn't be doing triage until you've had some good long experience in the ER. I started doing triage about 3 mos after I got there and it was not fun....learning as you go is not the way to do it.

    The starting difference between traditional military triage vs. civilian triage is also interesting. In military triage, the goal is how to use X amt of resources to save/support the most amount of patients. In civilian triage, acuity is the guiding factor. In my facility, tho, i have noticed that the military physicians are less likely to order massive workups than the civilian docs.

    As far as LWBS patients...at some point we have to rely on people to take their own responsibility for their lives. As long as they are relatively mentally stable, ppl are always free to go in my ER....well except for...kids, drunks, active duty military, TB patients, smallpox vax'ers, psychotic or suicidal pt's, fit for confinements.........oh, never mind. Have a seat! Be right with you!
  3. by   nursebonkers
    Quote from erdiane
    I believe we see approx. 50,000 per year. we are a level II er. We only have 10 beds, 4 of those are designated "fast track". We are busy all the time. Just can't believe that we are now responsible for people who want to leave. (Please, please stay! My manager will yell at me if you go!............... )
    HOly ROly!!!! Obviously your management and admin need to make your ED Bigger*** You need at least 25 beds for the amount of patients you see, I say let the s*** roll up hill !!! If they fire anyone take the admin to court! It is fiscally and physically irresponsible for your Hospital not to expand the ED!!!!!! Althougth I wouldnt worry about being fired, you could get a job within 10 minutes down the road!! :hatparty:

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