[SueBe40]

Just wondering if someone has information on Patient Classifications for ED's. I'm looking specifically for 5 tier systems. Am working for my BSN after 15 years and need it for a senior project.....due end of Oct. 02

If you can help THanks in advance

[JJFROG]

About 1 year ago in the Journal of Emergency Nursing was a good article. I will try and hunt it down for you with the specific publication date. Maybe some of the Canadian nurses can help out as I think that it is mainly used in Canada. We are still on the 3 tier system but I think the 5 tier makes more sense. Good luck.

[BrandyBSN]

do you mean like

1) non-urgent
2) stable urgent
3)unstable urgent
4) emergent
5) immediately life threatening

[SueBe40]

Thanks for responding. I'm not sure about the 5 tiers of the system, but your list looks like it would fit. I am looking for the names of particular systems that are actually being used. The acuity system also should able to work into the staffing patterns.

As I am a Med/Surg RN, I really don't have a clue as to how that kind of classification system would work.

I appreciate any help I can get.

[JillR]

How can you possibly use an acuity system for staffing in the ER? You never know what is going to poll through the doors. The only thing you could possibly do is project what might happened by using what usually has happened in the past, and that is many time inadequate. Is that kind of what you mean?

[SueBe40]

Jill, you said exactly what I did when given this project. Currently the system in use is one of trending.
I understand there are systems out there, but am having difficulty locating them.

[JillR]

I am sorry if I offend you here SueBe40, but I just can't help thinking that is a very risky way of staffing an ER. Hope that the hospitals that impliment staffing based on an acuity system for ER has very good insurance. Hope the nurses and doctors do too. WOW! One more question I am going to have to remember for future job interviews.

I say the people that think up these "trends" have way too much time to think up all these inovative ideas and really need a dose of reality if they are going to staff safely.

[JillR]

Good luck though on your project. If I come across any information about this I will pass it on.

[JJFROG]

I have looked all over for my old JENs and must have been thrown out in my move. Sorry.

[KKERRN]

We use a 5 tier system in our triage:
Level one- critical-immediate
Level two- unstable- 5-10 minutes
Level three- potential unstable- 30-60 minutes
Level four- stable 1-2 hours
Level five- routine- 4 hours

The time frame is the expected time to get the patient from triage to room in the ER and have RN/MD at bedside to continue triage assessment and begin treatment.
Level one the patient is taken straight to the back and the triage is at the bedside while family member gives our unit clerk information to generate a chart.
This system is not used to staff the ER because there is no way to predict what comes in. We have our regular staffing grid guide lines for how many RN,techs, ect to staff by each hour of the day. This grid guideline is used from previous visits to the ER...they log hour by hour the number of patients seen (not the acuity level) and the nurse manager staffs accordingly.
We have an on-call RN to utilize for urgent staffing needs. The patient acuity level can change in a heartbeat from stable to critical... it's the nature of the beast in ER.
Does this help you?