Quote from beekee
If you read the screening questions off the computer in a monotone voice, then the questions are probably not that useful. However, I look at my patients, sit next to them, and ask gently. You'd be amazed at the responses you'll get. The charge nurses have frequently commented on how often my patients admit to feeling depressed/suicidal when I happen to be the nurse. (And no, I don't work in psych).
The paradox here is that while the ED seems like a great opportunity because of the sheer number of people we see, that itself, along with the setting, makes for an extremely poor screening procedure (to the point of being embarrassing and awkward because of the glaring lack of time to develop rapport). Unfortunately it's not uncommon for screening to be made part of the triage
process, to make matters worse. So here's how that goes:
There's a list of questions. Basically you need to get through them AFAP. A general expectation for most triages is that they will take a few minutes or less. So, while getting vitals and double-checking the name/DOB:
Basic relevant med/surg hx
How did you get to the ED today?
Ever been a smoker?
Any chance you could be pregnant?
Recent travel/been out of the country?
Is English your primary language? If not, what is?
Are you living in a safe place/any concerns about your living situation?
Anyone hurting you?
Any thoughts of hurting yourself or anyone else?
No? Ok, great, have a seat and we'll call you when we have a bed.
Mind you, I am
trying to make eye contact, trying to convey my interest and attention, but the bottom line is to keep things rolling.
I, too, have never had anyone surprise me with a response. Really....not once. That's not to say there are not depressed, suicidal or homicidal patients that I triage. Just that no one has ever surprised me with a response to the rapid-fire question routine, which was not thought up by anyone currently doing the job of triage, I can promise you.