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Discussion

ED triage

A question for all you ED nurses. When the pt. walks into the ED what is the first thing that they do? (ex. see a Greeter who takes name and dx, see a triage nurse who takes name and dx, write their name on sign in sheet and sit back down...) The reason I ask this question is that I am aware of an ED where pts. come in and put their name on a sign-in sheet and then in order the triage nurse will call them into the triage room. The problem with that is you have no idea what the cc is and pts. can be sitting out there in the WR for an hour before anyone sees them. And by not knowing what the cc is you don't take anyone out of order as maybe you should.

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Here you see a nurse or tech first. If you see the tech first she calls the nurse in right away.

The hospital I work at is the same way. You sign in and wait to be called by a triage nurse. If someone is complaining of chest pain or is passed out then of course they get moved to the front of the line. But if the pt. doesn't speak up, then they wait like everyone else. Not my rules, but thats how it is here.

Our local ED will assess the CC and then decide whether it is life threatening...

The patient approaches the desk, where they speak to a nurse that takes the chief complaint. If they are not having a life-threatening condition, then they step a few feet away to register to get into the computer. Then, depending on how busy we are, they may go back to a triage room, or have a seat to wait to be triaged.

If their condition is bad, then they go straight back and bypass us.

That's how we do it. Hope it helps.

We have a quick look nurse who talks with the patient upon their arrival at triage. Based upon their complaint and appearance he/she makes a quick judgment call as to which ESI Level he/she thinks they will be The patients are registered at the same time and then sent to triage based on the presumed ESI Level. The triage nurse can change the ESI Level once she completes the triage. This gets the ESI Level 1 and 2 patients directly to a bed in a very timely manner.

Barbara

  • Guides

I am not an ED nurse anymore but I was 2 years ago. In the Level I Trauma ED I used to work in, we have a preliminary triage nurse who asks for the patient's chief complaint when they walk in. They also do preliminary interviews such as allergies, meds, medical history and such. This nurse decides whether the patient goes into the triage area right away or can wait to be registered first. In the triage area, there are more than one triage nurses. They check vitals signs, do stat EKG's for chest pain patients, and decide what category the patient falls under based on the urgency of their presenting problem. Patients who are brought in by ambulances go straight to the triage area and are not seen by the preliminary triage nurse. Traumas and medical codes are called by EMS beforehand so that the trauma/ED code team is ready to meet the patient at the door.

In our ER, the pt signs in with registration first. They get the name and cc. I really do not like this b/c I think the 1st person a pt should see is a medical type person not registration. They do however, let the triage nurse know if cc is something like chest pain.

  • Experts

The ENA encourages the process where an experienced RN is the first person to greet the pt.

There was a thread a few months ago similar to this, but in more detail about the traige process in different hospitals. That may be of interest to you as well.

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