triage

[Uptoherern]

We've just been informed by our new er manager (an rn), that our LWBS numbers are too high. (Left Without Being Seen). Meaning the patients are not wanting to wait (sometimes 2-3 hours, not bad considering county hospital sometimes has 18 hr waits!), or they decided they aren't really that sick, or have gotten an appt with their dr...........whatever the reason. So she has put out a memo stating that "this WILL change!" We (the triage nurse), are to "go out in the lobby and check on patients" ............and do what, we wonder? Chain them to the chairs so they won't leave???? She then proceeds to write that "if I notice trends among certain nurses, these will be documented, and there will be Verbal Warnings!" (Like what comes after verbal warnings?) Some of our nurses seem to be stuck at triage every shift. Some, like myself, hardly ever do triage. I don't know why. How the hell are we supposed to keep people from leaving the waiting room? :angryfire We are all somewhat pi##ed off about this. I mean, if people are waiting........that means that we are FULL! and FULL means that sometimes we have people sitting in the hall in chairs, not even in a bed (because they are all FULL!) Good grief

We already have a policy implemented that we are to do vitals every 2 hours, on every patient (minimum) whether they are in the lobby or in the er. When someone leaves with out being seen, we are now to write up an incident report.......believe it or not....... with the reason they left. Hello, they don't always tell us they are leaving. Besides, if it is so busy, that I cannot get people into the back........how much time do you think I have to write up incident reports???? Aargh :angryfire

Just a long vent...........anybody else EVER had this happen? I mean, jeez, if they are well enough to leave, they probably didn't need to be in the er in the first place. and if they were really, really ill, the triage nurse would've found SOMEPLACE to put them in the er. Not back in the waiting room.

good lord.

[nursebonkers]

The hospital systems , health care systems suck, they are big corporate companies who wish to take care of patients on an assembly line, they dont realize that there are far too many variables from patient to patient. The hospital administrators job doesnt get changed as much as bedside nurses. They simply dont get it, were sick and tired of sh** rolling down hill. If every bedside nurse up and quit and joined an agency today, Hospitals would sink into oblivion, we would demand higher pay for being treated like dogs. :angryfire

[Uptoherern, RN]

We have 3 nurses quitting. One is an ICU/flight nurse/ER nurse (nights), one works 3p-3a on WEEKENDS, the other is flexible and works varied hours. Partly due to this. We have a meeting in the am (7 am, like us 3-11 folks are going to show us). To address our "issues and concerns". The mgmt is going to hear an earful from our main day charge nurse. I'd attend, but since it is now 0100, and I have to get kids up for school in 6 hours, I don't think I'll make it :angryfire .

[Uptoherern, RN]

BTW, when I left our 10 bed er, (4 fast track). we were holding 2 ICU admits, every bed was full including 3 in the hall that we don't count. and the waiting room had 20 to come in.

[teeituptom, BSN, RN]

sounds normal enough to me

and My ER is about 40 beds including 9 fast ones

Good luck meeting with admin I always find those meetings informative and they usually bring food with lois of sugar to defuse you

dont eat the sugar, Sugar

[Calfax]

erdiane

The small community hospital I work in see's 40,000 people per year. We have the largest influx of ambulances in northern california,700 ambulances a month. Recently our Emergency Department decided to do away with "triage" they now call it Rapid Medical Evaluation. This new system will have all walk in patient seen initially by a PA within thirty minutes of arrival. Once seen the PA will get labs, xrays ordered and immediatly treat those who would normally be seen in the fast track type system. Also included in this RME team will be a RN, LVN, and ER tech. This is supposed to decrease the wait times (average 2-3hours) and improve on the 9% of our patients who leave without being seen. This system will start March 5th. I am curious to see how effective it is, sound promising but well have to wait and see. I will post and let you know howi t goes in couple of weeks; and possibly you can make some suggestions in your department.

livandluver

How's this system working out for you? I'm a Navy ER nurse and this is similar to what we do in the military. As RN's, we have a very free hand as to what we can do at triage and I send people for all kinds of x-rays, order labs, give meds, fluids, etc before they ever reach a physician. This is not because I'm an old, salty RN....but because resources are so scarce, that it's necessary to do this, just to get ppl seen. However, we do have a series of guidelines/protocols that govern what we can do. But it's not uncommon, on busy nights, for me to splint fractures, suture marines, and discharge patients from triage, with a walkie-talkie consult from the doc.

When I was a civilian, at the facility I worked at, we had to wait for a physician to eval pt's before we could do a lot of things....and waits were hours. On the military side....waits are still hours but I can do things while they wait.

Also because I am military, we have an extensive series of clinics that I can book appts for patients to go to, rather than be seen in the ER. While this is nice, not every patient should go to a clinic.....and I often run into problems (re:shouting matches, arguments) with physicians over seeing or turfing patients. This presents enormous liability with EMTALA issues as well.

Could this work in a civilian setting, too? Does anyone have a system like this at all?

What's the hardest part about learning triage is just experience....you shouldn't be doing triage until you've had some good long experience in the ER. I started doing triage about 3 mos after I got there and it was not fun....learning as you go is not the way to do it.

The starting difference between traditional military triage vs. civilian triage is also interesting. In military triage, the goal is how to use X amt of resources to save/support the most amount of patients. In civilian triage, acuity is the guiding factor. In my facility, tho, i have noticed that the military physicians are less likely to order massive workups than the civilian docs.

As far as LWBS patients...at some point we have to rely on people to take their own responsibility for their lives. As long as they are relatively mentally stable, ppl are always free to go in my ER....well except for...kids, drunks, active duty military, TB patients, smallpox vax'ers, psychotic or suicidal pt's, fit for confinements.........oh, never mind. Have a seat! Be right with you!

[nursebonkers]

I believe we see approx. 50,000 per year. we are a level II er. We only have 10 beds, 4 of those are designated "fast track". We are busy all the time. Just can't believe that we are now responsible for people who want to leave. (Please, please stay! My manager will yell at me if you go!............... )

HOly ROly!!!! Obviously your management and admin need to make your ED Bigger*** You need at least 25 beds for the amount of patients you see, I say let the s*** roll up hill !!! If they fire anyone take the admin to court! It is fiscally and physically irresponsible for your Hospital not to expand the ED!!!!!! Althougth I wouldnt worry about being fired, you could get a job within 10 minutes down the road!!