Triage sucks!!! Any tips??

arual56 · May 26, 2007

If someone asks right off the bat how long the wait is going to be that puts a little red flag up in my mind that they are more that likely going to be a PITA. I'd say to over estimate the time when they ask and remind them that life and limb emergencies take priority. That way when they do become a PITA you can remind them of what you've already told them.

I agree, but I often answer them that their wait depends on them. "If you are dying I'll take you back as soon as I can. If you are in severe pain, I'll take you back just a little bit later. If you have a sore throat or a hangnail, the answer to your question,'how long will this take?' is, 'as long as it takes." I get some odd looks but they go sit down and wait. If it is a person who is trying to use sexual advances to get in ahead of others, and they are not emerget, they go to the bottom of the rack every time they come up to the window and try it.

Victoriakem · May 27, 2007

I agree, but I often answer them that their wait depends on them. "If you are dying I'll take you back as soon as I can. If you are in severe pain, I'll take you back just a little bit later. If you have a sore throat or a hangnail, the answer to your question,'how long will this take?' is, 'as long as it takes." I get some odd looks but they go sit down and wait. If it is a person who is trying to use sexual advances to get in ahead of others, and they are not emerget, they go to the bottom of the rack every time they come up to the window and try it.

ooooo YUCK! Sexual advances to get to the top of the pile???!!!

:barf01:

TrudyRN · May 27, 2007

Let me start off by saying I really do like my new position in the ER. It was a good move for me,....but how the heck does anyone spend 8hrs in triage w/out ending up feeling cranky, mean and down right nasty!!! It wears me out!! I'd rather stay on the trauma side a work back to back truamas all night than spend 8-12hrs in triage!! You just can't make most of those people happy!!! Last shift I worked was very busy,.rainy night,.lots of MVC's,..this adult woman walks in c/o abd pain, her Mom is with her,..I do my triage thing,.pt actually states she "feels much better now,.maybe I should just go home and see my reg Dr in the morning",.Mom says no,.you need to see a Dr. and asks me "how long is the wait?" Of course I can't really answer that question,..over the next hour a woman walks in with a 3wk old "help, help,.my baby isn't breathing",. sure enough I have a blue baby I rush back,..then a man who almost severed his arm w/a table saw,blood everywhere,.passes out in the floor in front of the triage desk,.rush him back,..a 6wk old "not acting right" temp of 104,.rush her back,..all of this in front of everyone in the waiting room,..then the Mom of the abd pain comes up and asks "how much longer are we going to have to wait?",.again I explain that this isn't first come first serve,.this is an ER,.we see the life/limb threatening emergencies frst,.she looks at me and YELLS "You mean to tell me that since my daughter isn't as sick as some of these other people, we could sit out her all night?!!",...uuuhhhh yeah,.pretty much!! Why is that such a difficult concept for people to understand???
ARGGGGGGGGGGHHHHHHHH,....ok,.I'll stop now,..anyone have any tricks on handling the people?

I don't suppose it would do much good to post a huge sign that says:

We see everyone eventually but we see the sickest and most seriously injured first, no matter who got here before them. No matter how long you have been waiting, if someone comes in with what we decide is a more serious problem, we will see the new arrival first.

"We want to help you but this is an emergency room. We have to see first the people we decide are sickest or most seriously injured.

We cannot accurately predict how long it will take to see you because, even it's fairly quiet right now, we never know who might come through the door and how sick or injured they will be. We might have to take them before you, so any time estimate we give you now can change without notice.

Please trust that we are doing the very best we can with the resources we have. We want to help everyone, we just have limited bed space and personnel and can move only so fast. If your problem is not too serious, you should consider seeing your own doctor instead of waiting here. Or you might want to come back another time but there's no guarantee that your wait them will be any shorter than now.

If you have a private doctor, call his after-hours exchange. Do the same if you are a regular patient at a certain clinic. There is a doctor on call for the clinic." (And have another sign with all the exchange numbers for all the docs and clinics in town, as well as some free phones they can use, paper and writing materials so they can write down what their docs tell them. Keep some phone lines clear so the docs can call back, in case the patient does not have a cell phone.) "Maybe he or she can tell you what to do by phone, maybe call in a prescription to a pharmacy for you, and maybe help you not have to be seen in the emergency room at all.

Here are some examples of what we consider serious and less serious:

someone not breathing vs. someone with a cold or flu symptoms

someone with heavy bleeding vs. someone with a minor injury

someone with a very high fever vs. someone with (whatever)

someone who is confused, having trouble breathing, suddenly can't

move a body part vs. someone in pain

someone in labor and maybe ready to deliver vs. someone passing

even a very painful kidney stone

someone who WE think is having a heart attck vs. someone weak and

vomiting

someone who is unconscious vs. someone having trouble breathing but

who is still breathing

We just can't see everyone at once and we have to make these choices and decisions that you might not agree with but we still have to do it.

We do not have blankets, food, meal tickets, toiletries, or medication for non-patients.

Do not ask us to check your blood pressure or anything else if you are not a registered patient. We legally can't do this.

We know this is probably not what you wanted to be told but we thank you for understanding that this is the reality that we have to work with. We will help you as soon as we humanly can.

Do not let your children run, yell, throw anythingin the halls or waiting room. They could get hurt or lost or could hurt someone else."

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Another thought: Maybe there needs to be a 2nd triage station. First you pass through one triage nurse, then you go to another triage nurse. This might at least keep them busy .

I assume your ER has a 24/7 Urgent Care station. Or is your only option when triaging to send them either to the waiting room or into the ER proper?

An after-hours clinic can help tremendously, say between 5p.m. and 0100 or something like that.

Not sure about the legalities, but if you had some PROTOCOLS/ STANDING ORDERS, the nurses could weed out and treat the more minor problems. The nurse can do throat cultures, do Steri Strips, order labs and x rays, probably a lot of other minor things, like give anti-fungal, antibacterial, and anti-inflammatory creams - if you have standing orders. Worth looking into.

Another thought: have a nurse doing teaching in the waiting room. Instead of the TV, make those waiting aware of how to treat common

non-emergent ailments, teach them how to recognize urgent vs. emergent vs. neither for many ailments.

Maybe you're already doing all of this but I don't know what else to say except learn not to expect from people in the waiting room other than what you get. It's a very frustrating thing but what else can you do? Sometimes, silence is best.

Another thought: Have a social worker available. Get an NP, PA, doc out to the waiting room every so often during especially busy times, if available, to try to knock out some relatively quick cases. Nab student nurses and med students to see what they can do - take VS, do some assessments, do teaching about how a hangnail forms, whatever - good learning experience for them, keeps patients busy. :idea:

And keep a blackboard or some kind of clock/scoreboard visible to patients that tells how long it looks like it will be at any given time. Even though this can change, it might cut down some on people asking you over and over how long it will be. "There are 75 people ahead of you." "We just got in 3 people who were involved in a very serious accident/a person with a heart attack/whatever."

There might be HIPAA woes to contend with but Legal should be able to work out most of these.

Work with churches and schools in the community to get people educated in proper use of the ER. They might listen to someone they respect in those settings better than to hospital staff. But I really think people need to be told the truth about the way ER's are run and how priorities are established. If we treat them with courtesy and truth, a lot of them will respond in kind. Some will be jerks no matter what but I think this is probably a minority.

KristyEDrn · Jun 8, 2007

Or if they ask which ED doc is working. Huge red flag. I never answer that one. I usually say, "I guess you'lll have to find out when you get back" or something like that.

I answer this one only if it is a doc that doesn't put up w/ BS and doesn't give an Rx for Vicodin, etc for every ache and pain like some of the docs do just to shut a pt up. You can see the dread in the pts faces immediately and it cracks me up!

JRapha'sRN · Jun 8, 2007

I answer this one only if it is a doc that doesn't put up w/ BS and doesn't give an Rx for Vicodin, etc for every ache and pain like some of the docs do just to shut a pt up. You can see the dread in the pts faces immediately and it cracks me up!

Me too! If they're going to leave AMA after getting to the back and seeing who the doc is anyway, I'll save us all the time and tell them at triage so they can leave. :lol2:

Just a side note: I don't particularly like triage, but I'm stuck at home on bedrest right now and would love to be back at triage!