[CoolhandHutch]

How does your facility do it?

We have a triage process without the ability (as of today) to obtain a 12 lead with having the patient moved into an ER bay. On the patients that read the manual and know what they're supposed to do when having "The Big One" (SOB, diaphoresis, left-sided crushin pain), we hit the mark without a problem. The issue is the "soft" or evolving STEMIs.

We're a 8-bed ER with 6 urgent care/Fast track beds with around 14,000 ER/20,000 Fast Track visits.

[alkaleidi]

Everyone is educated. Techs generally grab an EKG machine the second it's known a chest pain is being brought back from triage or coming in via ambulance. Registration folks know that chest pain or anyone symptomatic of a heart attack needs to be brought back right away, or at LEAST they notify the lead nurse or pull a nurse to come out to registration to see the pt... a known cardiac hx with some sort of MI sx (there are so many these days, so different, sometimes it's better safe than sorry) is a "Bring them back so we can get an EKG now." I think it's just a case of really educating the staff to all be on the same page.

[Zookeeper3]

now our er is 36 beds... but upon triage, a chest pain is pulled into a "diagnostic room", we have two... an RN with in 10 minutes, runs a chest pain order set:

pt. gets ekg by RN, cxr PA and lat, labs without IV are drawn, full panel, ck, trop, sma7 or chem 7, abc. Then the RN ISTATS or has a machine that runs ck/trop in less than 2 minutes, a strip is run of the results and posted. If a suspicious ekg or elevated ck trop in non renal, gets you a monitored bed stat, a negative sends you out to the waiting room to be on yellow status. If the ER is maxed, vs are retaken in one hour with a brief hook up to monitor to run a strip, each hour....low risk factors, long wait, you hit hour 3... ck and trops and ekg are drawn again per protocol. .

We may have 36 varied beds, not counting a seperate peds, but we usually have an 80 patient wait list. So every hour reassessment is challenging, despite needed.

The ekg, despite what the RN reads is handed to a ED doc and signed off as read by him/her with the date and time with their initials.

I hope this helps. Being small does not change the care or process involved, time to thrombolytics or cath lab does. Hence the diligence. If you lack an ISTAT to run the labs, your procedures and process need updating,..... time is muscle

[Zookeeper3]

sorry, needed to add real work, with over 80 patients waiting and stretchers filling the hallways, we DO pull patients into the bathroom, pull a patient out of a room, one into the room to do an ekg, you work with what you have. Even with our two "diagnostic rooms", they are full of re- vital sign patients and there can be too many to handle and the ER crew pulls a waiting room back to draw labs and run an EKG and either keep 'em in the back or send 'em back out. We shuffle. Renal chest painers, keep us hopping... "well I missed dialysis because of holiday dinner..." UGH!!!!! for another thread anyway

Triage on down time will resample vs but has no capability to do blood draw or ekg. But they help. You really have many options to monitor out there, if someone is sitting, they could be reassessing. A waiting room code is shameful and unnecessary.

Tell us more about where you can or would like to change your process...... that may help.

[ERRNTraveler]

An EKG machine should be kept in triage specifically for this purpose. Then an EKG can be done during triage for anyone presenting with chest pain. It should then be signed off by the doc, and usually, if it's normal, the pt. can get labs drawn & then go back to the waiting room until a bed is available.

[RNcDreams]

Ours is similar.. there is one exam room adjacent to the waiting room for this exact purpose. Anyone who needs an EKG can go in there and get it, come out to the lab chair, be "lined and lab'ed" and then if the wait is that bad, they are sent back to the waiting room and hop to the front of the line.

[meandragonbrett]

Our triage area are private curtained off rooms. We draw labs and do an EKG during triage and go from there.

[biker momma]

Our ED has close to 50 beds (including fast track rooms). Currently a patient who presents to registration with any of a list of symptoms is walked to the triage nurse immediately. We page for a ED tech to do a stat EKG, give ASA, NTG, we can start a line, draw blood and order tests from triage. If the EKG shows a STEMI the patient is roomed and cath lab called. We actually had a patient one day that never made it into a ED room - EKG, ASA and IV lines started in a wheelchair in triage. From triage the patient went to the cath lab! I love when the planets are in alignment. Now that is an exception but our door to balloon times are generally very short. We have a team working on improving our triage system and will soon have a RN at the registration desk in the ED.

[LilgirlRN]

Hospital I used to work in, if you were over 35 and had chest pain, you skipped the triage office and went to a room.... when available. We have 8 monitored rooms, most of the time I can triage soemone and get them to a monitored bed if needed. We also have rollaround ekg/monitors that can be pulled into a non-monitored room if need be. Right now there is only one triage nurse at a time here so it would be impossible for me to do EKG's and start lines in triage. We do have a good track record, most acute MI's are in the cath lab within 30 minutes of hitting the door. I only know of one person coding in the ED waiting room.... not on my watch.

[mmutk]

First of all a patient with chest pain checks in up front, as with any other patient NAME, BIRTHDAY, and SOCIAL SECURITY are obtained by the greeter put into the computer
and the patient apears with an account on our tracking board (in the waitroom section).

They are called by the triage nurse into triage and triaged, DURING the triage process an EKG is performed by either the RN or Triage ER Tech.

It is our policy that an EKG MUST BE OBTAINED in the first ten minutes of a patient's arrival. It works well and 100% of our STEMI's have been to the cath lab in under 45min.


fyi: registration is completed at the bedside after the patient is assigned an ER bed.