Hi..just wondering if anyone is using a shortened triage form or has a really efficient triage process. Currently, our triage form includes everthing from chief complaint, to a list of all medications, surgeries, past medical hx. etc. Sometimes, this can take up to 15 minutes on the complex pts. When this happens, it backs up the waiting room, registration, ED, and fast track. Ideally, according to ENA, a triage should only take 2-5 minutes. I really would like to know what works at your facility. Thanks!!
Dec 17, '05
Well there is triage and then there is information intake. Actual triage can only take a minute or two. The most efficient I have seen was when I was working at U of M. We used the Emergency Severity Index and each pt was greeted by a nurse who immediately assigned the pt a class based on complaint and first impression. 1 or 2's would be taken back to the treatment area. All others the were further assessed and information entered in to the computer system by the other 2 nurses assigned to the area. If based on additional information the pt could be up classed by those nurses as well. Typically no one ever waited longer than a couple minutes to see the greeter/triage nurse.
Dec 17, '05
We use the ENA's ESI system also. The key is to have an RN greet the patient and take the name, birthdate, and complaint (these are the three pieces of info that our computer system has to have). Then, you go from there.
Dec 17, '05
Best triage I have worked with is the one that used the ESI system. Currently where I am I believe I am working on the "worst" We have a check sheet for initial assessment- and they expect us to fill it out in triage. I find it odd that they want me to assess bowel sound with someone sitting in a chair. etc. I think the full assessment should be done by the primary bedside nurse. But I am a traveler and so I tend to sometimes have different ideas.
Dec 17, '05
Where I recently started working we use the ESI which was recently implemented. I use to teach the ESI classes at my former ER, and the system does a pretty good job at sorting patients. What gums up the triage process is when management gets involved, people who don't triage regularly or docs who want every possible detail on the triage note before they see the pt.
The triage nurse should not have to order labs/rads for protocols (an extra 30-60 seconds), do a complete physical (another 30-60 seconds), nor all the other little things that commonly occur at triage.
The triage nurse's job is to sort pts by dying vs. not-dying, then with the not-dying: sick vs not sick, using quick assessment tools (VS, focus assessment, focused hx taking) and assign them to the approrpriate level.
The funny thing is, at my new job, we were having a relatively busy day, and I was maintaining a 10-15 minutes wait from check in to triage even during the I don't want to go back to work lunch hour rush. At about 1400 the ESI 'expert' gave me a break for lunch, 30 mins later I come back and see 7 people waiting to be triaged and only three people having been triaged while I was gone (2 catagory 4s, and one catorgory 3). It took me about 40 mins to catch up dealing with the "I just stopped by on my home from work' rush and the backlog left by the other nurse.
What annoys me is that, since I am 'new' my advice on improving triage taken at damn near worthless. Shoot, turned this into a rant, sorry.
So my advice is to now the triage system that is used in your hosp. better than the managers, so you can back up what you do or in telling them that that is not your function at triage.
Dec 24, '05
We use the CTAS 5 level system. It works well. Pts. are first seen by a RN and then after triage completed, they are registered by the admit clerks. If they need immediate assessment, they are brought in directly to the appropriate area.
PM me if you would like this information emailed to you.
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