Do you let ambulances drop off in triage?

getoverit, BSN, RN, EMT-P · Feb 19, 2008

I think it's perfectly fair to triage ambulance patients depending on their complaints. On occasion we let paramedics decide whether they are "triagable" or not, of course these are good medics with excellenct reputations and the complaints are extremely minor (e.g. chronic back pain for several years that has mystified doctors everywhere, has massive supply of percocet but is requesting vicodin; fears they may have a panic attack in the future and wants a script for Ativan; herpes outbreak, etc....you know how the list goes on!)

It is utilitarian to reserve the beds for the ones who have the greatest need, and also it may be a little "professional discouragement" when people realize that just because they arrived by ambulance does not mean they needed to be transported by ambulance and they will not automatically get a bed and seen immediately by the MD. When I worked fulltime as a paramedic and people would call 911 with the most trivial of complaints, I would often call the ED and speak with the charge nurse. Give them a brief overview and usually would end up relating to the patient that they would be placed in the waiting room at the triage desk and be seen in the order of severity. Of course I wouldn't refuse to transport or tell them they wouldn't be seen by a doctor, but there were lots of times I'd put someone at the triage desk and they would get tired of waiting and leave before their name was called. Miraculous recoveries and the charge nurses always seemed appreciative to get a "heads up" instead of just getting a radio report and having to make a decision with only a few minutes before our arrival.

CritterLover, BSN, RN · Feb 19, 2008

as described, both of those ambulance patients would go straight to triage, probably even if there were beds available, and no one waiting.

triage is there just to triage.

the nurses in the back have a bunch of stuff to do. since we don't have an "ambulance triage" nurse (i've seen some ers that have a nurse dedicated to that), sending them through triage can be a better use of resources.

it seems like it would be quicker and more efficient to off-load the patient straight into a room, but (probably due to the set up) it doesn't work out that way.

mianders, RN · Feb 19, 2008

We send ambulance patients to triage all the time. If there are beds open and no one waiting it is a different story. If you have a patient that comes in by EMS that could have walked in, or gone to their PCP and you have people in the lobby waiting for hours ( some of which could be very ill) I would definately send them to triage. There is so much rediculous stuff coming in by EMS. You do have to evaluate the patient before you send them out there though.

bill4745, RN · Feb 20, 2008

We send ambulance patients to triage all the time

Ditto that. And boy do they get mad sometimes!!-many think that because they arrived by ambulance their tiny, non-bleeding laceration will get them instantly into a room, sutured in minutes, and a free ambulance ride home, all in less than an hour.

Altra, BSN, RN · Feb 20, 2008

Ditto that. And boy do they get mad sometimes!!-many think that because they arrived by ambulance their tiny, non-bleeding laceration will get them instantly into a room, sutured in minutes, and a free ambulance ride home, all in less than an hour.

Ain't it the truth ...

A non-emergent chief complaint should absolutely go to triage. I'd make exceptions for non-ambulatory elderly patients or mentally challenged patients.

ERRNTraveler, RN · Feb 20, 2008

I'd send both of the patients you described to triage. If there are others who have been waiting for hours, they should be brought back first, and the new ambuance patients can now take their turn at waiting for hours......

Never underestimate the value of a "therapeutic wait".......

RedSox33RN · Feb 20, 2008

Yup, it doesn't matter the mode of arrival, though the pt thinks it does! If they are triaged a green, certainly the 2 chest pain pts are going to be seen before they are. They may have to wait another 2 or 3 hours or even longer. We had flu patients waiting upwards of 8 hours last week while we got trauma after trauma, and they did wait.

Only about 10% eloped and realized that they really could be seen at one of the many, many urgent care centers spread out all over the city. A select (very select!) few even realized that they could go home and take Tylenol and drink fluids and be miserable there, rather than not take Tylenol (so we know how high their fever is, of course!!) and be miserable, and exposed to every other virus imaginable, in our ED waiting room.

mandasueRN · Feb 20, 2008

We have an ambulance triage and an ambulatory triage at our facility. If you come in by ambulance with a minor complaint--my toe hurts, my back has hurt for two years, I have itching and discharge, etc--they get sent straight out to the waiting room where they have to sign in and be triaged in ambulatory triage. A lot of the medics that we trust with our ambulance service will wheel the pt into triage with a "hey I got a whatever and we're going to the waiting room." Most of the time we're like "Ok."

I hate it when people come to the ER for stupid reasons.

RedSox33RN · Feb 20, 2008

I hate it when people come to the ER for stupid reasons.

I know I'm new to the ED and have much to learn, but what really ticked me off was the 18yo, no hx of mental illness BTW, who called 911 for abd. pain. Turned out she hadn't have a BM in 36 hours. That's it. No pain from said "constipation", but that she found it very "unusual" and felt something may be wrong as she normally has a bowel movement every am. Doc was po'd, primary RN was really PO'd, and pt became very PO'd that she was put in ED waiting room with "all those sick, throwing up" people and left there for hours. She eloped, after trying to get a cab voucher. Nope, we wouldn't give her one. Have to be seen first.

I told our EMS that the county should look forward to billing her for every penny they possibly could. I don't want the county or taxpayers to get stuck with it, but wouldn't it be great if the insurance company denied her claim for EMS services and she had to pay out-of-pocket?!

ZippyGBR, BSN, RN · Feb 20, 2008

regardless of p method of transport peopel should get the same initial assessment process , however if you can trust your crews you can short cut this upto a point becasue they can decide waiting room - talk to triage / shift leader/ needs an room /bed

alkaleidi · Feb 20, 2008

In our ER these types of ambulance calls get a hallway as they come in. Only one of our charge nurses sends them to the triage to wait their turn, which I think is fair.
What is it like at your hospital?

Well thank the lord all of our lead nurses are all for sending non-ambulance-material ambulance pts out to triage. I can't count the number of people who have come by ambulance, been taken out to triage by wheelchair, and then gotten D/C'd from triage by the triage MD. Then they get mad because "since I came by ambulance you need to call an ambulance to take me home!" No sir. :nono: Here's a list of taxi's, or the bus stop is right across the street.

I have sent MANY patients to triage from an ambulance stretcher. TOTALLY appropriate to do so, and it is practice in our ED when triage is open to do that especially when we're full with 5+ overflow beds. Nothing irritates me more than having to move someone like that out of a room so a STEMI can have a bed with a cardiac monitor in the room. HMM.

Now the ETOH or drug detox/withdrawals, I don't ever send to triage (unless it's the "My son smoked marijuana yesterday, and today I want a psych eval to find out why he's using drugs"). 1, you never know what happened prior to them getting brought by ambulance or police -- might need a CT, fluids, monitoring, crash cart. 2, could become combative, assaultive, and otherwise dangerous to a waiting room full of patients and staff.