triage

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    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

    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.
    Last edit by erdiane on Feb 27, '04 : Reason: spelling

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  2. 41 Comments...

  3. 0
    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
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    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!............... )
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    p.s. I believe our left without being seen percentage is 10%.
  6. 0
    Quote from erdiane
    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

    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.
    What planet is your manager from?! You can't do anything about people leaving because of the wait! Suggest to her to try talking to the docs that staff your ER about how long they are taking per patient. If patients door to door time is extensive because the ER docs are doing unnecessary workups on nada patients then maybe it's time to light a fire under their butts. Docs doing that are the chief reason our ER gets backed up. If we have any of our treat 'em and street 'em docs, then the wait isn't nearly as long. If the wait gets long when they're here then we are busy with SICK patients that need to be here! Hang in there. Maybe a staff meeting would be in order if everyone else feels the same way you do.

    As for who gets stuck in triage, sometimes certain people get stuck out there because the charge nurse doesn't like them and doesn't want them working next to her. It's not fair, but I know from experience that that does happen. If everyone is sufficiently trained in triage, then everyone should take their turn. Sometimes I like working triage, especially when I am out there "keeping the peace". I have time to visit this website like I'm doing now!

    JMHO,
    Pam
  7. 0
    yup....we thought it was a bit silly, to put it nicely. Actually, that memo had quite a lot of nurses upset. The margins were used to write such comments as " a bit hostile?", and "maybe you need to check on other hospitals LWBS percentages are".

    What a lot of chickens we are. I suppose we should get together on this and do some reality orientation for the new mgr., instead of writing useless little notes.
  8. 0
    Maybe the unit's energy would be better spent on the people who stay and actually need emergent care.

    We also have a policy for vitals Q2H which seems like overkill when they are spending hours waiting for docs, waiting for labs, and aren't sick. Even worse when you know that on the floor they will immediately go to Q4-8H, it's just busy work at times.
  9. 0
    We had a memo very similar to that not long ago. We do try to check on people in the waiting room but when you're so busy you're running them through triage like cattle, and have a rack full to be triaged, and hunting rooms down all at the same time.......and then when you do go check on people, they eat you alive. Where's the love? hahaha
    I am one person, and I can only do as much as I can do!!
  10. 0
    One step at a time, sweet Jesus
  11. 0
    that is absolutely the most ridiculous thing I have ever heard! Giving nurses disciplinary action because people leave?? stupid STUPID!

    I think your manager needs to get a grip and come back to planet earth. We do Perts on the patients who leave, but frankly no one cares why they leave, its just one less person to have to take care of. We see upwards towards 60,000 people per year and we do not have a fast track, and sometimes people leave. Thats their prerogative and we cannot make them stay. Frankly only about 30-40% of our walk in patients really need to be here. The rest are all using the ER as a doctors office with 24 hour service.


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