Triage times (under 3 minutes) - page 2

How many of you deal with others who have long triage times? I'm talking 8, 10, 15 minute triage times. In the meantime you have people checking in and they just keep stacking up, sometimes without... Read More

  1. by   canoehead
    It's hateful when you get someone who is over 90 years, but has a low triage score. They shouldn't have to sit for 6-8 hours, but the sickest need to be seen first. It's always a dilemma.
  2. by   ~♪♫ in my ♥~
    I go for a thorough and appropriate triage. Sometimes 2-3 min if the complaint and history are simple, the patient is communicative and cooperative, and our wait times aren't long. If the wait times are long, though, I do a much more detailed focused assessment and note so that if they crump in the WR, I've clearly documented how stable they are on initial contact.

    Speed counts but takes a back seat to thorough and accurate.
  3. by   KeeperMom
    Quote from canoehead
    It's hateful when you get someone who is over 90 years, but has a low triage score. They shouldn't have to sit for 6-8 hours, but the sickest need to be seen first. It's always a dilemma.
    In addition to acuity, we prioritize our elderly patients. Anyone over 75 gets a * in their column and we try to get those pts back as quickly as possible and even faster if they are a higher acuity.

    I'm pretty good at the triage thing and can typically triage a straightforward patient in 5 mins or less. Of course, if the patient has a lot going on and needs some additional questions / history and/or an EKG, it might take a minute or two longer.
    We used to have an NP in triage and that took slightly longer with each patient which caused a few complaints but we did get more done with them out there because they could order labs, imaging, etc.

    We get the chief complaint, med and surgical history, LMP, allergies, tetanus status, we ask about malignant hyperthermia, ht. and weight, fall assessment, vitals and name of PMD. Luckily, we can pull info from previous visits regarding allergies, home meds, PMH and surgical history which has saved us a boat ton of time!
  4. by   JKL33
    Quote from MassED
    How many of you deal with others who have long triage times? I'm talking 8, 10, 15 minute triage times. In the meantime you have people checking in and they just keep stacking up, sometimes without relief triage staff to bail you out. My frustration is, where I work, we try to keep our triages to 2 minutes. Other than triaging a baby or psych pt, all other triages should be quick.

    What kind of direction or feedback could I provide to those that are repeatedly less than swift? There is no fire under them, it is just their pace and inability to go faster, or lack of concern. I am not sure which, but it is a problem. I don't know that a direct "you need to triage faster" will be effective.

    Thanks!
    Has everyone received recent ESI training, or a recent refresher?

    Perhaps a reminder of the department's goals for triage times VS. the current averages? Communicate with nurses individually if they are outliers (I personally would not respond well at all to the idea of individual nurses' triage times being posted up against peers, even though I triage quickly and accurately. I think that's a degrading way to treat a professional, but to each his/her own...)

    Perhaps revisit the amount of triage information currently expected to be collected to make sure as much non-essential information has been eliminated from "triage" collection as possible. Triage has become perverted to the point that there are a significant number of people who can't even define it properly any more because departments have added so much data collection to the process that people now think that's what it's actually meant to be.

    I love triage and go about it systematically as mentioned by other posters. Multitasking isn't optional. I think it's a critical role and some people have more of a skill for it than others. I do think there are some who probably just shouldn't be asked to do it....for everyone's safety and sanity.
  5. by   oldandintheway
    Median times may be more helpful than average times, I also see many unqualified nurses in triage roles. I think the worst thing is when a provider interferes by trying to start an assessment to preserve their door to doc times. I also think fast typing skills is essential, I know it slows me down.
  6. by   JKL33
    Quote from oldandintheway
    I think the worst thing is when a provider interferes by trying to start an assessment to preserve their door to doc times.
    Ditto...also loathe.

    But, I've put my attitude in check because what I loathe even more is the issue I described above. The provider is there to see the patient, which is [used to be] the ultimate end goal of "triage". It's not their fault that I still have half a dozen irrelevant questions to ask. And certainly not their fault that we're apparently now taking our benchmarks from those relevant to automotive assembly lines and using them blindly and broadly to evaluate the care we provide to human beings in a variety of situations.

    However, I still give the evil eye if they insist on interrupting my effort at an accurate blood pressure!
  7. by   gemmi999
    I'm reviving this thread because I've been an ER nurse for 3 years, done triage numerous times. Normally quick and on it with regards to triage but today was a *horrible* day and I need to vent. We were short staffed, I was *always* behind in triage because right when I'd catch up a family of 4-6 people with flu like symptoms would show up, all speaking another language which necessitated using the language line/computer (which takes 5 minutes, on average, to set up).

    So, so, so many flu-like symptoms, especially little ones, which needed mediation for fever because their parents didn't give them any at home. Which means i have to enter the order, walk to med room to get the medicine because we no longer stock tylenol or motrin in the triage room, and then medicate pt.

    All of this interrupted with ambulances that kept coming and then more and more critical patient's ending up in beds which meant backlog in the waiting room of pt's and we don't have standing orders except EKG and meds for fever, so none of them are getting worked up and they are *constantly* knocking on the door in triage and won't stop until you answer it, interrupting your triage. Only for you to tell them that they need to wait, and their little *angels* fever isn't an emergency.

    More then once I'd go to the pixus to get meds for a pt and end up triage an ambulance run that needed to be hooked on a monitor, etc, because the pt was *seriously* ill. One was there status post CPR w/ intubation and the RN just shrugged and took their other pt. to the floor/transferred them because they were already in a wheelchair for transfer. I can't leave a pt. who was just *intubated* who was hypoglycemic and hypotensive and there are no other RNs around because of short staffing.

    Or when the Charge tells you to take your lunch and then says she won't be in triage because she's covering someone else but she'll bed people who have bad chief complaints like chest pain/resp. problems, ignoring *all* other triages!!! WTH?!?!

    So when you get back from your 15, because you don't feel comfortable leaving the triage room empty for 30 minutes when you're already backed up by at least 8 triages and you have 15-20 now, and the charge just shrugs and says: "they're all minor problems".

    Including a girl who fell and "hurt her belly". And the parents don't tell you the full story and you find out later they left out details that would have up triaged them and you feel horrible about it! Example--a child fell on the playground and someone landed on top of her, hurt her abd. Normal vital signs, no pain on palpation, smiling, playful, parent states acting appropriate and back to normal self. Parent states they might leave. Encourage them to wait, make her a level 4 because she might need a CT/x-ray to rule out abd. injury but everything looks good.

    Later learn she has a liver injury because parent didn't mention that when pt. fell, she fell into a hard arm of a chair and the person who fell on top of her was 60 kg heavier. Parent had implied to triage RN that it was someone the same size and onto a flat surface. UGH! If they had added those details I would have made her at least a 3 and told the MD to work her up from the lobby just to be safe!

    Luckily she's fine but seriously, this annoys me and it makes me feel insecure, like I shouldn't be doing triage. *sigh*

    Which is a long rant to say that I had a long, long shift that was 15 hours because night shift was just as short staffed and they needed someone who could just float and start IVs/help out until it calmed down a bit. At least it's over. *sigh*
  8. by   ~♪♫ in my ♥~
    Oh how I loathe triage.

    It ranks right up there with feeding GoLytely to a demented, nonambulatory LOL with a stage 3 sacral ulcer.
  9. by   LilgirlRN
    Under 4 minutes you're gonna miss something. With triage like you're talking I would have to redo everything myself when they got to a room. Plus, most patients wanna tell you ALL about it. You can redirect over and over but their current problem really started in 1979 after the birth of their 3rd child.... You know how that goes. Sounds like you need more than however many triage nurses you have now.

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