Change in Triage Policy

Specialties Emergency

Updated:   Published

Specializes in ER.
Change in Triage Policy

So we have always done triage the usual way, catching patients as they arrive, assessing them and then assigning them to the relevant waiting room to see the doc.

Now we have a new policy. We no longer prioritize seeing patients on arrival, but now wait until they have a room and triage them just before they see the doctor.

As an old timer, this feels very unsafe. We know nothing about the patients until we triage, so of course a lot are being dispatched to inappropriate rooms, when they actually need a specific area such as iso, gyne or the eye exam room.

Time to triage now averages >40 minutes, previously it was around 15.

Apparently we do this to reduce the numbers of "left without being seen", but I feel that we are putting data over safety.

Thoughts?

2 Votes

Reality is that your option is to just let them run their little experiment however they want to.  Speaking from experience my belief is that they do not care about your concerns. Meanwhile, in the US, % of pts who LWOBS is a CMS quality measure; again based on my experiences I believe there are any number of brilliant schemes admins are willing to try to make important metrics outcomes look better.

There is no triage at a place that just puts everyone somewhere and gathers basic information just prior to pt being seen by provider. They are willing to take on the possible risks of not having a triage process so that they can try to make a certain metric look better. ??‍♀️

I don't mean to be negative/defeatist, just realistic when I suggest that you decide now how much this needs to bother you. For example, if this new process involves blindly putting patients into your care area that you are responsible for but don't have time to "triage" because of the ongoing care of other patients, it may bother you a lot since you cannot meet your responsibilities. On the other hand, if you're just worried about patients being placed in a regular room when they need a gyne room, that isn't too worrisome, they can be moved if needed.

If this is actually professionally problematic, leave. Otherwise roll with it until they cook up their next ploy.

3 Votes
Specializes in Community health.

Wow— sounds incredibly unsafe. If the person is in active labor or anaphylaxis, how is anyone going to know?  

1 Votes
CommunityRNBSN said:

Wow— sounds incredibly unsafe. If the person is in active labor or anaphylaxis, how is anyone going to know?  

Yep.

I've been in places with direct/immediate bedding....of an already triaged patient, so that a low-acuity patient is put into a care area following triage as opposed to back to the waiting room.

Don't get me wrong, the overall idea that all patients will be seen as quickly as possible regardless of acuity is not a bad idea, when you don't do that you get the stories about a 14 hour ED wait (or longer).

But unfortunately what these direct bedding schemes ultimately accomplish is putting the patient into an area that is assigned to some specific RN--so if/when that goes bad because that RN isn't able to check on them/get them settled and assess them quickly enough d/t other already ongoing obligations, there is a particular person whose "fault" it is--THAT RN who had a patient in their assigned area and didn't provide appropriate care.

It pretty much sucks about as much as all the other schemes associated with crappy staffing.

1 Votes

Sounds like you're referring to the "pull till full" crap that seems to be making its way around for the last few years. 
and maybe, yeah sure... as long as you have somewhere to pull them to. 
 

But what happens is the manager who likely hasn't touched a patient in 6 years got all excited when he/she read an article about pull till full and thought the added benefit is saving money on the triage nurse that you don't need since you're essentially direct bedding the patient. 
BUT... this only works when you don't have a wait in the waiting room and always have beds available. And we all know damn well that 1, 2, 5, 9 hour waits are indeed a thing - but hey pull till full is one of those catchy phrases that sounds impressive in their own ears when they drop it in huddle and even better when they're talking to hospital admins who aren't even nurses. 

1 Votes

Wow that sounds so unsafe!  I hope none of the patients waiting 40+ min to be assessed have a critical illness!  I've been out of ER for a good while but our goal was always triage within 10min.  Who is deciding where to put them?  The triage nurse or a tech? Is the expectation that the primary nurse comes to assess/triage immediately on arrival to the room?  What happens if they are busy?  Also what about the patients in the lobby when rooms are full?  And what about 10 min EKGs on chest pain pts?  Definitely a lot of questions and I'm sure probably no good answers.  This sounds like an attempt to improve CMS measures without actually working on the underlying problem or improving quality of care. 

1 Votes
Specializes in Pediatrics, Emergency Department.

It sounds irresponsible of management to implement something like that, but not surprising? I wouldn't agree to work triage, that's for sure. Also, management may have read a research article pre-covid and thought it would work. Today, too many people are in the waiting room for many hours to do this. There are too many risks for decline to wait for a provider/assessment.

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