Door To Doc, Team Triage, Rapid Medical Evaluation . ..

xonursej · Mar 31, 2011

I work in a hospital where the first contact is a tech and they get the pt info, why they are here, and then they get vitals. They then call the triage nurse and they come out and triage them near the waiting room in a private area. This is just basic info, nothing too detailed. The charge nurse or triage nurse assigns pt's to rooms as they come available. All patients are triaged and given a priority level which tells us who will be the next to come back. For instance, if there is a level 2 (high acuity/urgency) that just got here and there are other lower urgency patients, the level 2 goes back FIRST. This may make people upset, but its how the ER works.

xonursej · Mar 31, 2011

Also, in cases where there are NO rooms available for EMS/ambulance patients, we triage them and put them in the waiting room as well if they are low acuity. If they need to be moved immediatly to the bed, we can take a pt out of the room and make a hall bed and put the ems patient in the room.

Michele1377 · Mar 31, 2011

We have gone from a traditional triage system (patients signed in on paper slips, then were called into triage, then registered, then called to tx area based on acuity and bed availability) to a modified triage system (pt's quick reg'd, then called to triage for basic screening, ie vital signs, chief compliant, "eyeballing", then directly escorted to an avaiable treatment space) to a triage bypass system (patient greeted by non medical "greeter" walked directly into department, swing by charge nurse to tell them you are putting ABC patient in XYZ bed and assigned to a nurse based upon the bed they land in and someone is supposed to get over to the patient to do a full assessment and triage in a "timely" fashion)

IT BLOWS

that said - they have essentially taken the nurse out of the processs of having the ability to assign patients based on nurse/patient acuity mix, nurse ability, patient needs, etc. Also, they have tied the nurses to being assigned to beds and not patients (something we have been dealing with and trying to adapt to for months now). This combined with the loss of the benefit of having the patient screened before you are assigned to them, (no less not even knowing you are assigned to them util you notice that the greeter even put the patient in your bed) has made for some really scary scenerios.

I just am trying to ascertain if anywhere else is doing this or if our hospital has morphed a solid principle into their own convoluted and inexplicable brand of chaos? (wanted to say a word that rhymed with buster and truck but thought the better of it :cool: )

xonursej · Apr 3, 2011

We usually have a triage nurse asses and assign an acuity before they are assigned a bed so we can determine how serious the matter is. If there is a chest pain, we have to do an EKG within 15 minutes and sometimes it is so busy and chaotic that it becomes a mess. When its really busy, the docs will order things and want us to do them in triage. Its crazy trying to do labs and what not while quick reg. patients. They expect things to be done within so many minutes and it gets to be stressful when its busy because you have to repeat vital signs every hour and so basically you never get a break to even sit down for a second and breathe. Then people get angry with you because people go before them and this and that, but they do not realize that their are people who are sometimes sicker than them and need to get back asap. Frankly, if you are waiting in an ER you should be thankful because the people going back immediately are really sick.

xonursej · Apr 3, 2011

I wish urgent care centers were affiliated with hospitals so that the ER could deal with real emergencies. Any toothaches, colds, etc could go there while the ER can do its job. When there is a real emergency everyone is going to have to wait and it clogs the system because you have so many people now a days going to the ER for low urgency things. Some people even come well baby check ups. Maybe it is just me, but it would make things a whole lot easier if people knew how to tell from an emergency and something a fam physician can treat. FYI never ever go to urgent care for abd pain, 9/10 you will be coming to the ER for another bill.

Michele1377 · Apr 3, 2011

I really would like to see some sort of position paper or statement or recommendation from the ENA regarding this practice. I do not see how you can have a lay person in the waiting room taking chief complaint statements from people makes for good practice when the person getting inside may indeed be far sicker than origianlly thought or les sick and just tying up hours that would be better used taking care of someone who needed immediate attention. Personally, I just think it has been an issue of faulty implementation in the case of the ER I work in, but I would like to attempt to make things better for all of the patients and the nurses through discussion with management. I just want to make a solid argument as to why it is better to have a triage nurse (or any type of screening assessment) by someone with some sort of knowledge base.

Editorial Team / Moderator · Apr 3, 2011

ENA has a position paper about triage qualifications, and item 1 in the paper states that it is the ENA's position that triage should be performed by a registered nurse.

http://www.ena.org/SiteCollectionDocuments/Position%20Statements/TriageQualifications.pdf

Not sure if you need a membership to see it, but there it is.

Michele1377 · Apr 3, 2011

As for the ENA, I have a membership - am I'm even certified, LOL -

I know that they have a position on triage - what I am seeking is guidance as to when triage should occur. If we have non medical people walking patients into the treatment area and placing patients into beds without any prior assessment other than chief complaint - who is responsbile for the patient prior to them being triaged? The nurse assigned to that bed? Who's responsibility is it to tell that nurse that there is a patient in her area? And how does that nurse how to prioritize her work if she has nothing to go on beyond a chief complaint? For example spontaneous headache is not the same as a spontaneous headache with a BP of 234/122 or a headache after falling down a flight of stairs - you know?

I really need some sort of help with this issue - the ER nurses at my hospital were invited to go to the next labor/managment meeting to bring our concerns forward - we would like to do it with some sort of evidence on best practices - not merely our own opinions, (which have been easily disqualified by management as us having been resistant to change)

Thanks,

Michele