Hypothetical situation: you have 10 people in waiting area, 2 of which are chest pain and 4 of which are cold symptoms and lacerations, 4 others definitely need a room, but can wait. You have 2 empty rooms and 3 hallway stretchers. Mind you, people with lats and cold have been waiting for 2 hours to get in and it is 8 pm.
Ambulance calls with : a) detox patient, who is a+O and comes in every week to sleep and eat, then D/c when he feels like it b) a 21 year old college student with ankle pain.
What do you do?
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.
My personal favorite is the disgruntled pt sitting in the waiting room for a bit, leaving, going home to call 911, then ending up right back in my triage area to wait some more. Sorry, because you called 911 does not get you immediate medical attention, plus, you have just increased your wait time because you go to the back of the waiting list for your headache.
Believe me, they are not happy to see my smiling face again.
The other night had a 19 y/o male came in with Mom. Mom says he has a kidney stone and needs Morphine now. The kid was hurting,.I have no doubt,..but we had 38 pts in the waiting room and were holding ICU pts in the ER because we had no beds. Very crazy awful night. We put the kid in a wheel chair and triage him,.let the charge nurse know we needed to find a hall bed somewhere to put this kid in. 17 minutes later, Mom hasn't left the triage desk,.is telling her son to yell a little louder,."make some noise,.start kicking things and they'll find you a bed". The kid was pretty quiet durring all of this and even told his Mom to "stop" a couple of times. While all this was going on we had about 15 family members waiting to see a Class I teenage trauma pt that we weren't expecting to make it.
She then leaves with her son,.goes to her car in the parking lot and calls 911!! I kid you not,...of course that takes a few minutes so we assume she went to another hospital,..kick him out of the system as LWOT (left without tx) and passed the chart on to the chart faries. EMS calls report and we all about died!! They went to triage to start all over again,..but this time they came through the ER hallways,.and the pt says "wow,.it's crazy back there Mom".
A non-emergent chief complaint should absolutely go to triage. I'd make exceptions for non-ambulatory elderly patients or mentally challenged patients.
:yeah: I so agree! So many think just because they came via EMS its a straight shot to the Doc....if your back, toe, etc has hurt for 2 weeks then I think a good wait is just what you need.
The other night had a 19 y/o male came in with Mom. Mom says he has a kidney stone and needs Morphine now. ... 17 minutes later, Mom hasn't left the triage desk,.is telling her son to yell a little louder,."make some noise,.start kicking things and they'll find you a bed". The kid was pretty quiet durring all of this and even told his Mom to "stop" a couple of times.
I chart stuff like that while I'm in triage.
"Patient in waiting room sitting in wheelchair, respirations unlabored, appears in no distress. Visitor who identifies herself as patient's mother standing next to patient, states to patient, 'make some noise, start kicking things and they'll find you a bed.' Charge RN aware of patient, awaiting available bed."
Isn't that the goal of all documentation -- paint as clear a picture of the patient as possible?
"Patient in waiting room sitting in wheelchair, respirations unlabored, appears in no distress. Visitor who identifies herself as patient's mother standing next to patient, states to patient, 'make some noise, start kicking things and they'll find you a bed.' Charge RN aware of patient, awaiting available bed."
Isn't that the goal of all documentation -- paint as clear a picture of the patient as possible?
I put all that stuff in quotes, too- covers my butt if they decide to complain to management later- it shows how unreasonable they were being......
Hypothetical situation: you have 10 people in waiting area, 2 of which are chest pain and 4 of which are cold symptoms and lacerations, 4 others definitely need a room, but can wait. You have 2 empty rooms and 3 hallway stretchers. Mind you, people with lats and cold have been waiting for 2 hours to get in and it is 8 pm.
Ambulance calls with : a) detox patient, who is a+O and comes in every week to sleep and eat, then D/c when he feels like it b) a 21 year old college student with ankle pain.
What do you do?
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?
Whether you get an immediate bed or not is based on your complaint and what other patients are there waiting. It has nothing to do with mode of arrival.
The detox patient, so long as he's cooperative and not urinating all over himself, can go to Triage. He's a wildcard, if you will, as you need to see how much of a problem he's going to cause in the waiting room. The last thing that you need is to rile up the whole place!
The ankle guy can go to the waiting room and get his XR.
Chip.........Yep...we've had many of those. People who abuse the system need to be educated. I loved the article I just read about having a co-pay for minor ailments. Even @ $20, that would be more expensive then had they gone to the pharmacy for their non-emergent, treat and street ailment.
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.
We did exactly the same thing at my previous place of work and it worked well. people need to realise that just because they call an ambulance doesn't mean to say they will get treated quicker. How many times have you hear a non-emergant patient say that they are going to go away and call an ambulance so they get seen quicker. Go on then, buddy boy, but your wait will only begin again.
God, what a horrible mess ER's are in. And the public, too. I hope we can straighten this out soon so ER's are utilized more correctly and so people can get good care, no matter what their ailment, no matter what time of the day or night it is or what day of the week.
"Patient in waiting room sitting in wheelchair, respirations unlabored, appears in no distress. Visitor who identifies herself as patient's mother standing next to patient, states to patient, 'make some noise, start kicking things and they'll find you a bed.' Charge RN aware of patient, awaiting available bed."
Isn't that the goal of all documentation -- paint as clear a picture of the patient as possible?
Yeah, but if it ever became a legal issue, your quoting her might portray you as hostile toward him or her. Not always good to be totally graphic. Often, the less said, the better.
We triage all of our ambulances as they come in, regardless of where they go-if it is deemed that they go to triage, then off they go. We triage them first before sending to the lobby
:yeah: I so agree! So many think just because they came via EMS its a straight shot to the Doc....if your back, toe, etc has hurt for 2 weeks then I think a good wait is just what you need.
911RN
16 Posts
My personal favorite is the disgruntled pt sitting in the waiting room for a bit, leaving, going home to call 911, then ending up right back in my triage area to wait some more. Sorry, because you called 911 does not get you immediate medical attention, plus, you have just increased your wait time because you go to the back of the waiting list for your headache.
Believe me, they are not happy to see my smiling face again.