We no longer triage

Specialties Emergency

Published

We have this new system in the 25 bed in which I work.

No triage. Charge rn goes out, and get's pt's as they come in. Has a brief conversation on the way to a room. We are adversising a fast door to doc time, and docs often get to the pt before the nurse.

We will fill our beds, sometimes with minor stuff. Pt's in a bed have a much greater expectation of service than a pt in a waiting room, taking a lot of nsg time on minor pt's.

The docs can only move so fast. We get the "seen" quickly, but I don't think we get them out any quicker.

Anybody else use this system? Does it work?

I'll put it politely by saying I'm not a huge fan.

HH

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Specializes in Level 1, Level 2, Level 4 trauma and med.

yes, I know of 2 hospitals in Iowa that "meet and greet," and pt's go straight back to a room if available. The bases for it is all about pt satifaction. Pt's don't want to be triaged .They want to see a doctor. So to keep them happy, you try to get the pt back to a room, doctor and nurse come in at the same time, so there is only one question period, and the treatment regimine started.

It works as long as you have enough room, and staff that are multi-task oriented. There has been research done regarding this type of "through put" and the pt's like it. What they haven't studied is the impact it has on the staff. It can be tough to process 4 pts in 20 min. Some folks just can't drop what they're doing to go see the new pt that was just put back into a room. And the system is as strong as the weakest link. More of the future of healthcare.

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That sounds horrible! What happens in a case of all rooms being filled & a chest pain comes in?

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Totally not safe.

But will probably addressed when you start coding someone in the waiting room.

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Specializes in Level 1, Level 2, Level 4 trauma and med.

The same thing happens with overflow if your doing triage, or not. You put people in hallways, you do EKG's ASAP, and use your critical thinking skills to match wits with obstacles.

Once all the rooms are full you go back to your basic triage. So the "new" system defaults to the "old." Happens eveyday, somedays sooner than others. It's crazy, healthcare is crazy, ER nursing is crazy, but that's why i dig it so!!

BTW at a local hospital the head nurse of the ER came in with her H who was having C.P. and the ER was full, waiting for triage he coded in waiting room. So that happens regardless of what type of triage your doing.

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Specializes in home health, dialysis, others.

I say we are doing it backwards - - let's have a DOCTOR do the triage. That way a DOCTOR gets to decide who needs to be seen first, and the patients are all seen by a doc right away.

People will be happy to know they have spoken to a doc -even if that particular doc is only deciding on their place in line. And maybe some of the people will just go home if the doc says there are 27 people here with more serious issues than yours ........

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We triage and then put everyone in a bed. We have a new, big ER and it seems to work ok. You can still wait a long time, but are in a comfy bed. This seems to be a better solution. We still advertise as "no wait" but there's some sense of prioritization still.

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We triage and then put everyone in a bed. We have a new, big ER and it seems to work ok. You can still wait a long time, but are in a comfy bed. This seems to be a better solution. We still advertise as "no wait" but there's some sense of prioritization still.

I'm curious all pt get a bed/not a trolley gurney?

do you triage to resus/majors/minors?

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Specializes in PACU, Surgery, Acute Medicine.
I say we are doing it backwards - - let's have a DOCTOR do the triage. That way a DOCTOR gets to decide who needs to be seen first, and the patients are all seen by a doc right away.

People will be happy to know they have spoken to a doc -even if that particular doc is only deciding on their place in line. And maybe some of the people will just go home if the doc says there are 27 people here with more serious issues than yours ........

This is how it works at the Missouri Baptist ED. A doctor sits in the triage area with the nurse. The RN does regular triage stuff, the MD is there so that if the pt can be shipped over to the clinic then off they go. So every patient sees a doctor first thing, and patients who aren't actually critical don't stuff up the ED.

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Specializes in ER, Oncology, Preop, Recovery.

Do you still have to do all the the triage paperwork/computer work plus your usual initial assessment paperwork/computer input? I guess yo do, at least list of meds, history etc. When we have triaged in the room, it was very time consuming because we had to complete the triage forms, plus input all of our assessment data. It would have been much quicker and easier if it could have all been integrated into one form/database. Sometimes people forget to complete the triage sheet and just do their usual assessment, getting into trouble later.

When there is an empty room, the triage nurses have been instructed to bring a patient straight back because studies show that it increases patient satisfaction. Or, if a patient is about to be dc'd, they can go out in the hall, and a new patient can go straight back to the room. It does, at least here, make extra work for the patient's nurse. It is always a surprise for the nurse too. I guess I am a little spoiled...I like to know (at least kind of) what the situation is before I walk into the room.:uhoh3: I'm sure we will all adjust soon!

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I say we are doing it backwards - - let's have a DOCTOR do the triage. That way a DOCTOR gets to decide who needs to be seen first, and the patients are all seen by a doc right away.

People will be happy to know they have spoken to a doc -even if that particular doc is only deciding on their place in line. And maybe some of the people will just go home if the doc says there are 27 people here with more serious issues than yours ........

Hey, that sounds like a good idea. That way, people are less angry and won't take it out so much on the nurses. People tend to shut up when they are around authority.

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Part of the challenge is that we adopted this system, without any changes to speed through put. For example, nobody went through the charting system to streamline it. Same "triage" as well as nsg assesments.

If I do my assesments while the Doc is in the room, it is more pleasant for the pt, but more time consuming for me.

We generally have no techs, so I am spending more time getting blankets, taking pt's to bathroom, etc.

I don't think we have studied it, but I suspect door to doc is much shorter, but door to door is longer.

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