Triage Practices - page 2

We are reviewing the away we triage patients in our busy ER- both walk-ins and ambulance patients. Please tell me how your triage system operates from point of entry until MD eval. Thanks... Read More

  1. by   RNin92
    Quote from gorilla
    Sarah,hi I would like your attachments if possible. Also, I have heard about the Canadian Systems and the Estimated Severity Index-would you know where I could get info on these systems? Thank you,Becky
    gorilla...
    I have little info as well...
    The ENA has the ESI 5 tier system info. Check out their website.
    The Canadian system is similar but there are times attached to each tier.
    I don't know about your hospital...but at mine...times being layed down like law could be the kiss of death for the health care giver and a "sweet surprise" to the litigators!
  2. by   Sarah, RNBScN
    Quote from gorilla
    Sarah,hi I would like your attachments if possible. Also, I have heard about the Canadian Systems and the Estimated Severity Index-would you know where I could get info on these systems? Thank you,Becky
    -----------------------

    Just p.m. your email and I will send them to you. Can you share the Estimated Index screen? Let me know.
    Thanks,

    Sarah
  3. by   FiestaRed
    After filling out a form that registers the patient's chief complaint, the first person a patient sees in the triage room is an MD. Follow the link below.

    http://www.cep.com/rme/rmesummary.asp

    -Mark
  4. by   Rena RN 2003
    all of our patients enter the same door, squads and walkins alike. in fairytale land, the patient is greeted by a nurse. name, ssn, dob, and general complaint is taken and the nurse decides whether the patient goes to a room, hallway, fast track, or lobby. quick reg sheet to registration so the name can get into the computer if we need stat orders for ekgs, chest x-ray, etc.

    the patient name is placed in the appropriate space on the general flow board with a circle left open so that a nurse can pick up that patient. complete registration is done at the bedside.

    that being said, i don't really care for our triage system. it only gives you an eyeball look at the patient but doesn't give you anything else to go on (i.e. vitals). it will sometimes land a patient in the track for a "headache, i've had them before" symptom until you vital them and the bp is 193/105 with blurred vision and nausea.

    we do the best we can with what the powers that be deem appropriate.
  5. by   gorilla
    Quote from Sarah, RNBScN
    -----------------------

    Just p.m. your email and I will send them to you. Can you share the Estimated Index screen? Let me know.
    Thanks,

    Sarah
    Sarah, my e-mail is bgiardin.chnola.org- I have not been able to find anything on the ESI yet-if I do I will be glad to send it to you. Thanks, Becky
  6. by   CSLee3
    My facility uses the T-system of triage and documentation...ALSO, very important here.....any ambulatory or ems patient ALWAYS speaks to a NURSE first, not a check-in clerk. Too many bad things can happen here, ie. the patient or the clerk, not recognizing impending doom... "T-system" triage and charting takes over on priority of patients. Once triaged, the pt, or relative checks them in with the non medically trained clerk. If arriving by ems, the clerk comes to bedside to check pt. in..................C
  7. by   Katnip
    We use the 5 level system to triage.

    Ambulance entrance is separate from walk in. Folks come to the registration desk first. We are all locked in behind a big glass and concrete wall. There is always at least one security officer at the desk to field complaints.

    On duty is one clerk, 1-3 security people, 1-3 RNs one tech, and one transporter. Staffing depends on time of day and how crowded it is.

    We have 3 triage rooms and five triage waiting chairs inside the triage area. Patient sees the registration clerk first, puts their basic info and complaint into the computer. All areas of the ED, main, peds, and our minor injury area sees who's in the waiting room and triage.

    The tech calls the patients back to us depending on how long they have been there, and does their vitals, then puts them in the triage chair to wait for a nurse. ONLY the patient is allowed back unless they need a translator or they are a minor, then only one other person comes with them. We rarely make exceptions.

    As stated everywhere else, if a person really does look emergent they go straight back to the main where the nurse there will triage them.

    The nurse in one of the rooms will call a patient in, triage them and assign their condition level and either send them back to the main waiting room, or call the charge nurse for a bed assignment. We used to be able to assign the beds ourselves, but that got a little crazy.

    If Peds isn't busy, they will call us an say they'll take patients. Nurses in the ED parts can also take patients by putting their bed number next to the pt name on the computer.

    Transporter gets the data sheet print outs and takes the patients back to their beds and instructs them to change into a gown.

    If a patient walks in with chest pain, we do the EKG in triage. If any patient looks like they will need a line and bloodwork, we do that in triage also when all other beds are full, and will keep monitoring them in triage until a bed is available.
  8. by   Sarah, RNBScN
    Quote from gorilla
    Sarah, my e-mail is bgiardin.chnola.org- I have not been able to find anything on the ESI yet-if I do I will be glad to send it to you. Thanks, Becky

    Hi Becky,

    Your email is not valid...it states "not a valid internet email". I attempted 3 times and made sure I copied it down but it didn't send. Is that an email address? Let me know and I'll try again.

    Sarah
  9. by   Sarah, RNBScN
    Quote from CSLee3
    My facility uses the T-system of triage and documentation...ALSO, very important here.....any ambulatory or ems patient ALWAYS speaks to a NURSE first, not a check-in clerk. Too many bad things can happen here, ie. the patient or the clerk, not recognizing impending doom... "T-system" triage and charting takes over on priority of patients. Once triaged, the pt, or relative checks them in with the non medically trained clerk. If arriving by ems, the clerk comes to bedside to check pt. in..................C
    -----------------------------

    Where would I find information on the T-system? Please advise.

    Thanks,

    Sarah
  10. by   gorilla
    Quote from Sarah, RNBScN
    Hi Becky,

    Your email is not valid...it states "not a valid internet email". I attempted 3 times and made sure I copied it down but it didn't send. Is that an email address? Let me know and I'll try again.

    Sarah
    Sarah, I am so sorry-should be bgiardin@chnola.org-thanks for getting back with me. Becky
  11. by   canuckeh!
    For information on Canadian Triage Standards go to the website for the Canadian Emergency Physicians< www.caep.ca>, click on Policies and Gudelines on the left menu, then CTAS on the top menu.
  12. by   NurseJacqui
    Quote from veteranRN
    In my personal experience, you have to be careful relying on signs that say "please notify nurse if you are having SOB or CP". I once went to an urgent care and sat in the waiting room for >1hour. My complaint? A heartrate of 38 (over betablocked). I never had chest pain but chest pressure. (I am an RN but didn't want to bother people because I truly felt it wasn't an emergency). Now aren't you glad I'm not triaging any patients :imbar

    I have a hx of SVT and I have never taken any beta blockers because usually it breaks on its own but one particular time it was persistent and I was starting to get a little lightheaded and SOB. I went to the ER closest to my house. The triage nurse put me in the waiting room with a HR of 185, I guess she dismissed me as anxiety. I never told her I was an ER nurse. By the time the doctor called me an hour later it had finally broke so I just left. I would NEVER put someone with a HR like that in the waiting room. But that's just me.
  13. by   veetach
    we see 125-175 patients per day, we have one triage nurse 24/7 and one tech from 7a-11p. Our patients sign in at a window, (the triage RN can at this time do a quick check to make sure the patient can sit in the waiting room without problems,) and then they are called back in order of severity of c/o. Our registration personnel do not see the pt until they have been seen by an RN.

    Our ER is most always full, and triaging has become quite an art. A good triage nurse correlating with a good charge nurse is the key in our er. When the patient is triaged, we enter their data in the computer (name, age, c/o) and do vital signs and a triage assessment, then they either go to the back to be put in a room or go to the waiting room. In an ideal world, our patients in the waiting room are supposed to be reassessed by the triage nurse every hour. (this never happens)

    currently we operate on a three level triaging system, but the 5 level is waiting in the wings...

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