Triage process

[emetcal1]

Well, we all know how frustrating triage can be. In fact, I try my hardest to never be up there because it stresses me out having people in the waiting room for hours with chest pain. It doesn't make a whole lot of sense to have someone with chest pain in the waiting for for 4 hours then bring them to a room and put them on a heart monitor. Okay, anyhow, what are any new ideas out there today to improve the triage process? I was a traveling nurse briefly and saw a few different ways triage functioned. My current job has a process where patients get in a line and there is a "first nurse" that lays eyes on everyone and can decide if someone needs seen immediately. The patient will then sit and get vital signs and wait in line again to go to one of the two triage windows. There, the patient will explain their complaints through a window to a triage nurse, receive a wrist band, then get directed to the registration window to update information. During peak hours, nurses or a triage doctor at the window will place protocol orders and the primary nurse will fill out a little ticket with patient information to receive an EKG if they complained of "chest pain". Of course, however, if a patient is diaphoretic with crushing chest pain, we do the EKG immediately. Our EKG times are still really terrible for STEMIs and it is just frustrating because it shouldn't be that way. Another pet peeve I have about this place is nurses will allow their patients to wait in their rooms after being discharged if they are waiting for a ride and received a narcotic. I feel like other places have a designated discharge area for patients with that issue. I am trying to throw out ideas to management because I am frustrated with the flow of the department.

Thanks all!

[MunoRN, RN]

The rule has been 10 minutes to EKG in every ED I've worked in, and there's a long list of people who would be throwing a fit if that wasn't happening (cardiologists, outcomes coordinators, etc) so I'm surprised there could be door-to-EKG times of 4 hours without anyone having a problem with it, maybe the proper people aren't aware?

[JBudd, MSN]

We have a cart in a cubical right next to the triage computer cube; and our door to EGK times are tracked and posted. Name into computer, call for EKG, put pt in gown on the cart, and can start the triage questions but our tech is usually there long before VS happen. EKG gets taken directly to an MD to be read and signed off on.

I hear the frustration of not getting them back, but when there are no beds and no spare monitors for the hall beds, what can you do? We don't have quite as many steps in the process as you describe; get registered, RN does the triage, and if there is space puts the pt in the fast track area for line and labs (Nurse initiated protocols), or straight into a room. PA/NP/MD sees them out front in fast track with the fast track nurse and tech, unless they are a level 2 or 1, most 3's also go back but can get started out front. I think my hospital must be much smaller than yours, at night my tech and I are the only ones in the front (fast track closed), and we register & triage everyone.

JEN has had quite a few articles about throughput, were any of those available or useful to you?

[emetcal1]

Well four hour ekg times is a bit of an exaggeration. It's definitely not always 10 minutes. It's frustrating to have the nurse behind a window. I feel like I can't get anything accomplished and sometimes can't even hear the patient. Ekgs are done in another room away from the lobby. I feel like if registration happened at the door and the first nurse would triage down the line instead of at a window, we can detect needed ekgs faster and we could have needed patient information to log into the ekg machine. Jbudd I haven't looked at those yet but j will do that for sure! I've been trying to look them up under my school's library (I'm in NP school now) but nothing is standing out. Our ER can have up to

94 beds with hallways included but we lack a lot of resources (no cath lab!! No trauma services ) so I've found working at a hospital that sees so many patient and few resources has been difficult because so many immediate transfers and done and that takes time.

[canoehead, BSN, RN]

We put chest pains on telemetry if the initial EKG is not acute. They get their blood drawn in triage and then go to the WR.

[JBudd, MSN]

Here's a few to start with,

Excellence in response: a hospital–wide journey in improving throughput for the ED patient

Cited in Scopus:

Kristine J. Mims, Alan Umbright, Kathy Crist, Timothy Thompson

Journal of Emergency Nursing, Vol. 29, Issue 5, p418

Published in issue: October, 2003

AbstractFull-Text HTMLPDF

Evaluation of a Flexible Acute Admission Unit: Effects on Transfers to Other Hospitals and Patient Throughput Times

Cited in Scopus:

Christien van der Linden, Cees Lucas, Naomi van der Linden, Robert Lindeboom

Journal of Emergency Nursing, Vol. 39, Issue 4, p340–345

Published online: January 16, 2012

PreviewAbstractFull-Text HTMLPDF

Bypass Rapid Assessment Triage: How Culture Change Improved One Emergency Department's Safety, Throughput and Patient Satisfaction

Cited in Scopus:

Penne A. Marino, Angela C. Mays, Elizabeth J. Thompson

Publication stage: In Press Corrected Proof

Journal of Emergency Nursing

Published online: October 10, 2014

PreviewAbstractFull-Text HTMLPDF