triage

LIVANDLUVER · Feb 27, 2004

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

Uptoherern, RN · Feb 27, 2004

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!............... :uhoh3: )

Uptoherern, RN · Feb 27, 2004

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

MrsWampthang, BSN, RN · Feb 27, 2004

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! :rotfl:

JMHO,

Pam

Uptoherern, RN · Feb 28, 2004

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.

**canoehead, BSN, RN** · Feb 28, 2004

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.

NativeTexan · Feb 28, 2004

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!! :uhoh3:

teeituptom, BSN, RN · Feb 28, 2004

One step at a time, sweet Jesus

veetach · Feb 29, 2004

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. :rolleyes:

Carotid · Feb 29, 2004

the way i see it, emergent they get back. if they come in smiling, eatin' tater chips and sippin' mountain dew, they can wait. if they leave, they didn't need to be there in the 1st place. our hospital has established county urgent cares (4), that treat less acuity walkins. when we have a high census in the hospital, holding 15-30 patients in the ed waiting for a hospital bed, i send them to the uc's (after initial assessment, and rate low on acuity) if they're willing, or they can wait 3-6 hours, i give them the option. i have full approval of charge nurse and nurse manager when doing that. hate it for those who get plastered b/c they couldn't get the uri back within 30 minutes.

Carotid

trsnurse · Feb 29, 2004

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.

We have to do incident / occurrance reports on all LBT's (left before triage), LBTC's (left before treatment complete), LBT's (left before treatment/seen by MD) , and of course the AMA's. At our hospital we have an incident report for EVERYTHING!! We also if I might add, have an assistant nurse manager that we can't figure out what exactly she does other than micro-manage (just recently learned from other er staff that this is how she conducts her time which means to focus on how many ways the RN's screw up). She is also the receiver of all these reports, as a permanent charge RN in the dept. I want to delegate all this (much ado about nothing) paperwork to her!!! But we also have a new director, she has been in her position for 2 years (about) and this is her 2nd assistant nurse manager, she seems to think this person is GREAT-- but for the most part I think the staff feels as I do (she would make a good hood ornament for my truck)!!

Okay back to your issue... We also have to check on patients triaged back to the lobby, at minimal every HOUR. But if they were in the lobby b/c we are full and can't get a bed for our patients who are sick and tirage is getting their teeth kicked in then how the He** can you begin to worry aobut those who have such complaints that they are triaged back to the lobby in the first place? We work on a 3 scale triage system-emergent, urgent, non-emergent, and if someone is non emergent then we place them back in the lobby-why would someone who sits in an office M-F 8-4:30 want to question why someone left to start with? well I do not have the answer to that; but maybe that is their "job security". We just get O.T. at the end of our shif doing all the darn paperwork associated with all the idiots who left and turn it in to all the idiots who require it!:angryfire

Our tirage is already a 40 minute dissertation as it is, we also do a community health screen, and the floors initial assessment when checking in every patient, so one can only imagine, we don't have time to check on every patient triaged back to the lobby. But I do forward the paperwork back to the appropriate person. Now I don't know if any of this is an answer--I think I just vent bit*hed. I guess we all live in the same screwed up ER world!

GOOD LUCK dealing with your new nurse manager and her new found power-we have been "enjoying" the same ride.