Triage in your ED

  1. OK to all the nurses out there that work in ED's.

    In our ED we have been seeing approximately 35,000-38,000 patients a year. Recently in the Cleveland area, two hospital systems have been trying to take over the market (IMO). Anyhow, with the increased ED volume d/t other recent hospital closings, longer lifespan, more patients in nursing homes etc, our census has skyrocketed, and we have seen many more patients than anticipated. One of the things I am currently trying to do, is come up with some new ideas on how to appropriately triage the large numbers of patients that come through the ED, more efficiently. So let me ask you a few questions about your ED's current triage methods, and your thoughts on them?

    1) How does your ED triage it's patients?

    2) Do you think your system works well? or not? If so why does it work or not work well?

    3) If you were to restructure your current triage system, how would you do it? Staffing changes? etc?

    4) Any suggestions on what thoughts might make a triage system better?


    Currently, we have one triage nurse in our system. This person is overwhelmed with way too many responsibilities. Triage itself, and communicating between family members, and updating them on their loved ones condition, checking the locked refridgerator for drug specimens, etc. Clearly too much for one person to handle on some of our busier days.

    Current thoughts:

    A) Using two nurses in triage, to assess get vs, and catagorize the patients as they come into the ed. Something along these lines?

    B) How to arrange it to be more expedient, and see patients soon as they come through the door, not 5 to 20 minutes later, or longer.

    C) In what particular way to use these two nurses?

    ****Note: For all those out there that are unaware of this fact: Iy is a violation of COBRA rules, to have the patient register, provide any demographic info, or insurance or payment, without being assessed by a health care worker first.

    Thanks for any input provided, Rick RN CEN
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  2. 9 Comments

  3. by   CHUBBY
    One ER I work has a RN and a tech assist. the tech does the vitals, ekg's, blood draws while the RN gets all the otherstuff. I still know of plenty of ER's who are still registering their pts first...which as you posted is a direct EMTALA violation
  4. by   traumaRUs
    This is a very timely subject for me as well. Our level one trauma center sees 60K plus pts/year. We have been restructuring our entire process for over a year. We are going to a parallel process. The pt comes in and is greeted by an RN who does a quick What can we do to help you? Then is the pt is deemed emergent, the pt is taken straight back to a tx room and vitals and everything else is done there. The only info the nurse gets up front is the complaint, name, dob and SSN if available. With this info the clerk gives us a chart and the rest of the clerical info is done at bedside with portable rolling laptops, anytime during the visit. If there are no rooms available, then triage proceeds per usual, obtaining vitals, etc. Its a lot more detailed than that so, if you want more info, email me: Dansizen4@webtv.net.
  5. by   CEN35
    Thanks for the input, hopefully some more of you nurses out there can add to it!!!!

    Rick RN CEN
  6. by   NANCY HOBBS
    Originally posted by CEN35:
    Thanks for the input, hopefully some more of you nurses out there can add to it!!!!

    Rick RN CEN
    WE HAVE A TWO TIER TRIAGE WHICH INCLUDES INITIAL TRIAGE (CHIEF C/O) AND TRIAGE. IN MARCH OF 2000 PATIENTS ARRIVING BY POV ARE SIGNED IN AT INITIAL TRIAGE AND ESCORTED DIRECTLY TO A TREATMENT ROOM WHERE TRIAGE IS COMPLETED BY NURSE OR NURSE AND PATIENT CARE TECH. IF SPACE IS NOT AVAILABE PATIENTS ARE SIGNED IN AT TRIAGE AND TRIAGED BY 2ND RN. TWO RN'S ARE TO BE IN TRIAGE AT ALL TIMES. AT TIMES THIS IS NOT POSSIBLE THEN A PCT WILL SIGN PATIENT IN AND TRIAGE IS COMPLETED BY RN. PATIENTS ARRIVING BY AMBULANCE ARE SIGNED IN SIMILARLY AT A DIFFERENT AREA. REGISTRATION IS COMPLETED IN THE PATIENTS TREATMENT ROOM.
  7. by   CEN35
    Thanks for the reply Nancy!

    Rick RN CEN
  8. by   CEN35
    Back to the top!!!

    Anybody else?

    Rick
  9. by   Brenda Braun
    Originally posted by CEN35:
    OK to all the nurses out there that work in ED's.

    In our ED we have been seeing approximately 35,000-38,000 patients a year. Recently in the Cleveland area, two hospital systems have been trying to take over the market (IMO). Anyhow, with the increased ED volume d/t other recent hospital closings, longer lifespan, more patients in nursing homes etc, our census has skyrocketed, and we have seen many more patients than anticipated. One of the things I am currently trying to do, is come up with some new ideas on how to appropriately triage the large numbers of patients that come through the ED, more efficiently. So let me ask you a few questions about your ED's current triage methods, and your thoughts on them?

    1) How does your ED triage it's patients?

    2) Do you think your system works well? or not? If so why does it work or not work well?

    3) If you were to restructure your current triage system, how would you do it? Staffing changes? etc?

    4) Any suggestions on what thoughts might make a triage system better?


    Currently, we have one triage nurse in our system. This person is overwhelmed with way too many responsibilities. Triage itself, and communicating between family members, and updating them on their loved ones condition, checking the locked refridgerator for drug specimens, etc. Clearly too much for one person to handle on some of our busier days.

    Current thoughts:

    A) Using two nurses in triage, to assess get vs, and catagorize the patients as they come into the ed. Something along these lines?

    B) How to arrange it to be more expedient, and see patients soon as they come through the door, not 5 to 20 minutes later, or longer.

    C) In what particular way to use these two nurses?

    ****Note: For all those out there that are unaware of this fact: Iy is a violation of COBRA rules, to have the patient register, provide any demographic info, or insurance or payment, without being assessed by a health care worker first.

    Thanks for any input provided, Rick RN CEN
    Some time ago JEN had an article dealing with a similar issue. The article suggested Having "teams" in the ED. The would consist of perhaps 2 RNs with an assigned UAP who has been trained to do EKGs, draw labs, basic splinting,dressings, transport, input lab orders ,ETC.. The Triage RN would always have a UAP in Triage to assist in "getting things started". The other RN on the team may help out in the treatment area until the need arises in triage- she may then help "double triage" ,perform ongoing assessments if warrented,help with UAP duties or whatever is needed. The other teams in "the Back" would cover areas and could then cover each other for meals,etc.. and if even more help was needed in triage one team member could go out and help.

  10. by   outbackannie
    In our Level II ED, we have 1 triage and 1 clerk. Pt arrives POV and fills out brief form - name, DOB, time of arrival, and chief complaint in waiting room. Triage nurse admits pt to triage area by priority, does complete physical assessment on computer using ProMed system, assigns to area of ED based on urgency. We have 3 areas- fast track for minor problems, critical area, and observation area. Pt then seen by MD who does exam, orders tests and treatments, which is computed by ED nurse. If pt is direct admit by ambulance - triage area is bypassed. In either case, clerk visits pt after seen by MD and not before.
    This system is pretty organized even when the waiting room is crowded and the ER is full, triage nurse still does assessment and pt's who are able remain in waiting room. WE have a hard and fast rule, no waiting for more than 15 min for intial eval and every 10-15 min until put in ER bed.
    Biggest problem is when the computer is down!
  11. by   CEN35
    Thanks for the two aditional replies........I was suprised to see them, 8 months later, after apparebtly most others decided to lay this one down to rest.

    CEN35

    Rick

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