does anyone have a policy?

[AmyRN]

I work in a 17 bed ED that routinely has more patients than it can handle. Does anyone have a traige policy that describes the amount of time you have to traige, assess and have a physician assess the patient from the time they hit the door? The policy that we have in place doesn't always work and we're looking for something better. Lots of busy nights people get impatient and leave after signing in, before even being traiged by a nurse. (Which usually makes us happy, but our management is starting to have a fit.) Also, how do you handle a patient signing in with their chief complaint and still safe guard patient confidentiality? At our triage office the patient signs in with a name, time and physician so we may have a chest pain or open fracture sitting in the waiting room and we have no idea that they are 12 patients down on the traige list. Or worse yet, it's a biohazard patient that just walks in and sits in the waiting room, contaminating the whole department before you know it.

Another issue is our new case manager. It's wonderful to have one full time in our department because now we can do patient care without having to worry about accessing the "free fund" for someone's medication, cab ride home, setting up PT etc, but we need a policy or job decription in place. Our case managers are also RN's.

[CEN35]

no policy based on time limits, at our hospital........that could be real tough if they did....and would never get met anyways. we are just way to busy. what they do....is talk to the triage nurse....or registration and infrom us why they are there.....and registration radios the complaint to us.....three of us have radios...charge or manager, triage nurse and registration.

what you do need to realize is emtala regulations, state a medical proffesional must evaluate the patient prior to getting any information (i.e. name age, insurance etc etc). there is a huge fine for this problem.

outside of that, there is the joint commsion who states, all patients must be triaged and evaluated by a medical proffesional (they claim rn, pa or physician) within 15 minutes upon arrival. according to them this entails name, age, allergies, hx, and vs.

everybody triages differently, some go through the whole spiel, in the little room and ignore the rest and do it one at a time, name, age, allergies, hx, complaint, time, date, etc etc.....this could take up to 15 minutes.

i catch 98% of my people right away....and just ask them why are you here?....evaluate the primary complaint within 30-60 seconds...decide if they can wait or not...and document it and the time...and go back to what i was doing. (i.e. patient with c/o difficult breathing.......(time)....bs/cta/bl/a&p....pox 99% pt naaad. (back to waiting) rg

one other note......alot depends on whether we ahev open beds or not? the above scenario is when there are no beds open. otherwise i roll people back into their rooms, and pawn the chart off to the triage nurse, medic, or primary nurse to finish while i catch the rest.

me :)

[debbyed]

We just started using a new form. Half sheet of paper from tear off pack(numbered) that patient fills out with name, DOB, Chief complaint and doctors name. They place it in a box. Each time the triage nurse finishes with a patient she collects the new forms and calls patients based on what they wrote.

With our ER being swamped right now, this helps in seeing those more seriously ill before the cuts, bruised and sore throats. We have also cut down on the amount of information obtained during triage so that triage should take no more than 3-4 minutes per person. Detailed information is gathered after the patient is taken to a room.

If the patient is triaged Emergent they are taken to a room and bedside registration is done. Urgent patients may either be taken to a room and have bedside registration or wait in the waiting room with standard registration depending on bed availability. Non-urgent and fast track patients have routine registration done after triage.

Of course it didn't take long for our frequent flyers to figure out this system so they always write Chest pain or SOB. Course after triage they still get sent back to the waiting room when the triage nurse judges them to be non-urgent.

Many of our regular medics have even started to bring non-urgent patients directly to the waiting room in wheelchairs. (Boy does that pi$$ off those patients. They always yell that they came by ambo so they should get a bed immediately.)

[psnurse]

Triage into three categories.... emergent, urgent, and non-urgent.

Emergent means RIGHT NOW even if you think not humanly possible.

Urgent means as soon as humanly possible.

And non-urgent can wait as long as necessary.

[jimminy]

We also triage in three tiers, Emergent - go to the shock rooms or shock room halls. Urgent are taken to the holding area and must be evaluated within an hour. (the holding nurse does a quick foc used assesment again just to make sure this patient has not changed and needs to go to the shock rooms instead.) Nonemergent go to the waiting room and will be called one day. These should have gone to a clinic.. The problem comes when we change shifts. Depending on the previous triage nurse, we go back and reeval waiting room patients to make sure they are still non emergent , or triaged correctly. We also have anywhere from five to twenty patients waiting to be triaged, so the nurse will walk down the line, ask for chief complaints, look to see if anyone does not look so bueno. We do not want a cp wainting at the end of the line. The second problem is the urgent patients.

We have "slots" for twenty four in holding, but if they are urgent, they have to go back so we end up double and tripling slotting beds. This can get pretty crazy. We may need to look into bunk bed stretchers!

We have talked about goiing to a six tier system, but are having so many other changes right now, that has been put on the back burner. We are an inner city level one, county, so we have a lot of volume. Our Ems tries to help us out, but many wish to come here due to finances.

We also have a high DNA rate in the waiting room which helps us out, but upstairs frowns on.

Sorry, I really do not have bad spelling or grammar, but am typing in the dark on a little keyboard. I don't want to wake everyone up. I have also forgotten what the original question was!! I'm having a geriatric moment.

Hope everyone is having a good day, night, or inbetween.:)

[mikemw]

I work in an ER with 17 beds in the main ER, we have an additonal 8 nonurgnet beds that are used from 1100-2300 daily. The nonurgent area is staffed by a PA, 2 RNS an ER tech and a clerk. This takes the nonurgent load off the main ER.

When an ER patient enters our facility the first stop is at a window staffed by an RN who triages the patient. If there are more than one patient waiting to be triaged the triage nurse notes the patient's name ., chief complaint and time of arrival on an ER chart. The most emergent patient is then fully triaged with a goal of 3-5 minutes. this includes Vitals, allergies, meds, and significant history. If no-one is waiting to be traiged the patient is brought into the triage area where vitals, allergies, meds, and hx are obtained and a bed assigned if avialble.

If no bed is availalbe the ER chart is placed in order of medical need not order of arrival. If there is a differeence between arrival time and time the opatient if fully triaged this time is alos noted on the chart. If there is a delay between traige and the time the patient is assigned to a bed, this time is also noted on the chart.

EMS patches are montiored (not answered) by the traige nurse so they know what is arriving via ambiulance. If there are no or few beds available The EMS patient will be held at triage until those with more urgent illness or injury are being treated. We do not bump a more critically ill or injured person just because the patient is arriving by ambulance because our EMS, like most, are required to transport EVERYONE who calls 911 inlcuding the minor finger laceration or vomiting once in last hour.

[Sarah, RNBScN]

We have a 5 tiered system for triage.

I can share with you the package we have and a copy of our triage chart for adults and children.

Let me know. PM me if you are interested.

Take care,

Sarah