Triaging and patient load

[Beffers81]

Hello!

All though I'm fairly new in the ED; I'm highly observant to things that happen. My facility has a high turnover rate, mainly because it's a teaching hospital in a rural area, so people usually put in a year and then move on to someplace bigger. I was a floor nurse for 1.5 years and recently (April) transplanted to the ED. The turnover rate in the ED is much higher and for awhile I thought it was due to burnout but after being down there for a few months I've finally see the light.

The lead, triage nurse (or sometimes cna), and/or nurse first, UC will constantly slam a person with 4 new patients at the same time (ESI 1, a trauma, or other acuity); while other nurses will be sitting on one patient for a few hours.

My question is how do you facilities divvy up your patients as they come in? Do you have a system or is it like my facility where it's sink or swim with 4 new patients who may or may not been triaged. Are you told about your new patient? Most of the time if we are in a room with another patient and we get a new one we aren't told about it until we get back to our computers and realize "crap....I have a new patient who's been sitting there for nearly an hour with nothing done on them"

Thank you for your time

[amzyRN]

They shouldn't be giving you an ESI 1 and 3 other patients at the same time unless your resource nurse and other team members have your back and are settling your ESI 1. If you are stabilizing your ESI 1 and they are giving you 3 other patients who may or may not be stable that sounds like it might be a safety issue, unless your team members are picking up the slack, doing critical tasks and having your patients on the monitor at least. Either the triage nurse doesn't like you or they don't know what they are doing and someone else needs to direct the flow of patients through your ER.

[JKL33]

1) Why are UCs and CNAs ever involved in what is essentially nurse assignments? - - I'm assuming their role in this regard is to room patients, but IMO they should be receiving direction on "which room" from an RN if there is no separate system of assigning patient other than having them end up in a room that's already assigned to a nurse.

2) Do you not have computer access while you're in a room with a patient? So there's no system for knowing that you've received a new patient until you return to a desk area? That doesn't fly with me. I've encountered it before and made it clear that it was not acceptable, and charted "pt care assumed from charge nurse" at whatever time it was that I "discovered" the new patient. It stopped. Nurses must be informed or have a way to know when a new patient is received/assigned.

3) You list like 4 or 5 different individuals/roles that may be responsible for this process. How can that be? It sounds like there is little-to-no effort to control the chaos. I see two reasonable options: Either the Charge/Lead or the Triage Nurse should be overseeing this process.

[NickiLaughs, ADN, BSN, RN]

ESI 1s should always be given to the nurse with no other responsibilities. That patient is too sick.

Our triage nurse will sometimes direct room a patient without vital signs. However the primary Rn is notified as well as tech assigned that area. We have a computer system that we out our ESI levels in it's called TAZ) There is a doc and 2 RNs assigned to the different areas, and the taz equally divides the higher level ESI patients (1s, 2s and hard 3s). If we get a ESI 1 that usually goes to our resus room where an rn is just assigned that room.

ESI 2s and hard 3s are taxed and out in their area. The nature of the beast is sometimes one area will get the harder sicker patients and get backed up. Sometimes we will steal rooms from other areas if that patient is too sick for the lobby. Our soft 3s, kidney stones, vag bleeds are seen in the hallways or pelvic rooms and rotated to chairs or whatever spot we can find for them. They don't need a cardiac monitor so they don't need a real room.

Our 4s and 5s are rotated through a triage room with a doc and RN sitting there. They get their IM or oral needs right then paperwork done and out the door. Most of these lower level visits are well under 45 minutes, some under 5 minutes.

The reason we do this is because it keeps our lobby clear most of the time so we can keep an eye out for sicker patients and avoid the congestion.

We sometimes will see over 500 people in a 40ish bed ER in 24 hours and over 100 in our urgent care that is an extension of our ER.

Sounds like your ER isn't being fair, put in your time and move on. It's a lot of work to try to change a culture

[Beffers81]

Amzyrn....I don't think it's because I'm not liked. I think it's because the turnover rate is so high that we all lack a little bit of direction. It's frustrating because even when we do have a triage nurse; half the time the patients are triaged even when they've been in the waiting room for 2+ hours. A majority of the time there is a CNA in the triage room. We are getting a new lead who has experience working at other facilities; she had a patient she knew nothing about because she was taking care of a more critical patient; it wasn't until she got out of the room to the nurse's station she finally saw the new patient (by that time he had been there for about an hour and was getting discharged); she was really upset about it, so I'm hoping when she becomes lead things will change. I was seriously upset the last day I worked and contemplated going back to med-surg because of the lack of splitting the patient's up between nurses instead of getting multiple at one time.

[Kooky Korky, BSN, RN]

Well, as suggested, you could cut and run. Or you could grow up and try to improve things.