Triage-How is it done in your ER?

Specialties Emergency

Published

I was just wondering how other ERs triage. We are having a little conflict at work.....so how does everyones triage process work? What determines which patient is seen first? I will fill in the details later....just want to see how it works in other places. Thanks!

Specializes in Emergency Medicine.

Triage as a system is dead. Everyone has bowed down to the 5-level ESI system to "maximize reimbursement".

Now you get to charge for every little detail of a person's visit. Ooooh, you're a one. You're a two. There's not chit wrong with you but we have deemed you labor-intensive so we can stick it to you and your insurance. Way to go ENA. Way to go...

Triage? There's no such thing in a civilian system. Only in the military do they sort based on severity any more.

But, Love hearing about the way others nickel and dime patients in their facilities. Keep 'em coming.

We use an initial WAG index followed by a modified ESI.

We have no triage nurse, or triage room. A patient comes in and give the chief complaint to a clerk, who writes it on the tracker, and is instructed to call back for certain complaints. The charge nurse sees the tracker, and employs the WAG (Wild A** Guess) system to decide who comes back, and whether we are in a rush to get them.

If the pt has been coughing for a day, and says his chest hurts, we get a call from the clerk-"chest pain", and we rush out to get what may well be an ESI 5. Of course the person who's shoulder hurts after shoveling (actually left shoulder radiating to jaw) is left in the waiting room to infarct away.

On the way to the room, the charge RN has a brief conversation, and tries to figure out if there is an emergency. A nurse's name is assigned to the pt. Of course, if that nurse is involved in a 20 minute procedure, the pt is not seen by a nurse until then.

Once the staff nurse learns of the pt, and is able, a "triage" is done. It is based on the ESI, but none of the nurses have any actual training in ESI, and some are new, inexperienced nurses. Hence my use of the term, "modified ESI", which involves training and experience. About a quarter of the time, the nurse actually lists the ESI on the tracker. This isn't as bad as it sounds, as the triage is rarely read by the doctor anyway.

At some point, the doctor sees the patient. This can happen before, during, or after the triage. Since our docs are judged by door to doc time, they are penalized if they wait for a triage to be done. They often make initial decisions without important information, like vitals, and actual medication taken, etc. Also, some will come in right in the middle of triage and interrupt it, demonstrating the lack of value of triage in our system.

If anybody has a worse system, please describe it- I would be both surprised and impressed.

Specializes in Emergency/Trauma/Critical Care Nursing.
We use an initial WAG index followed by a modified ESI.

We have no triage nurse, or triage room. A patient comes in and give the chief complaint to a clerk, who writes it on the tracker, and is instructed to call back for certain complaints. The charge nurse sees the tracker, and employs the WAG (Wild A** Guess) system to decide who comes back, and whether we are in a rush to get them.

If the pt has been coughing for a day, and says his chest hurts, we get a call from the clerk-"chest pain", and we rush out to get what may well be an ESI 5. Of course the person who's shoulder hurts after shoveling (actually left shoulder radiating to jaw) is left in the waiting room to infarct away.

On the way to the room, the charge RN has a brief conversation, and tries to figure out if there is an emergency. A nurse's name is assigned to the pt. Of course, if that nurse is involved in a 20 minute procedure, the pt is not seen by a nurse until then.

Once the staff nurse learns of the pt, and is able, a "triage" is done. It is based on the ESI, but none of the nurses have any actual training in ESI, and some are new, inexperienced nurses. Hence my use of the term, "modified ESI", which involves training and experience. About a quarter of the time, the nurse actually lists the ESI on the tracker. This isn't as bad as it sounds, as the triage is rarely read by the doctor anyway.

At some point, the doctor sees the patient. This can happen before, during, or after the triage. Since our docs are judged by door to doc time, they are penalized if they wait for a triage to be done. They often make initial decisions without important information, like vitals, and actual medication taken, etc. Also, some will come in right in the middle of triage and interrupt it, demonstrating the lack of value of triage in our system.

If anybody has a worse system, please describe it- I would be both surprised and impressed.

Wow, lol that is pretty bad! What do you guys do if a high acuity pt comes in and there's no beds open?

Wow, lol that is pretty bad! What do you guys do if a high acuity pt comes in and there's no beds open?

Panic.

Our sister hospital has a nurse and a PA in the triage room. The PA does initial assessment and determines where u need to go ect.

Specializes in Pediatric/Adolescent, Med-Surg.
We use an initial WAG index followed by a modified ESI.

We have no triage nurse, or triage room. A patient comes in and give the chief complaint to a clerk, who writes it on the tracker, and is instructed to call back for certain complaints. The charge nurse sees the tracker, and employs the WAG (Wild A** Guess) system to decide who comes back, and whether we are in a rush to get them.

If the pt has been coughing for a day, and says his chest hurts, we get a call from the clerk-"chest pain", and we rush out to get what may well be an ESI 5. Of course the person who's shoulder hurts after shoveling (actually left shoulder radiating to jaw) is left in the waiting room to infarct away.

On the way to the room, the charge RN has a brief conversation, and tries to figure out if there is an emergency. A nurse's name is assigned to the pt. Of course, if that nurse is involved in a 20 minute procedure, the pt is not seen by a nurse until then.

Once the staff nurse learns of the pt, and is able, a "triage" is done. It is based on the ESI, but none of the nurses have any actual training in ESI, and some are new, inexperienced nurses. Hence my use of the term, "modified ESI", which involves training and experience. About a quarter of the time, the nurse actually lists the ESI on the tracker. This isn't as bad as it sounds, as the triage is rarely read by the doctor anyway.

At some point, the doctor sees the patient. This can happen before, during, or after the triage. Since our docs are judged by door to doc time, they are penalized if they wait for a triage to be done. They often make initial decisions without important information, like vitals, and actual medication taken, etc. Also, some will come in right in the middle of triage and interrupt it, demonstrating the lack of value of triage in our system.

If anybody has a worse system, please describe it- I would be both surprised and impressed.

This system sounds horrible. I wonder what JACHO and the other powers that be think of basically not having a nurse in charge of triage. I know some hospitals use paramedics for triage but at least they have some medical training

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