What happens when in your ER?
We have a two step process where one nurse assigns an ESI and the other nurse finishes up the triage process and can upgrade the ESI depending on the situation. Currently, the registration desk is closer to the ER entrance than the triage desk but here is a sign for the patient to see the nurse first, so they first walk to the nurse and then turn around and go back to registration, then they go back to triage. My ER is doing construction and we are hoping to have some of this fixed. Does your ER have registration simultaneous done with the initial triage? Do you have "quick reg"?
What is your process?
We have a large desk when the patients first walk into he ED and fill out the reg form with a CC. A "pivot" nurse asks what about the CC and might ask one or two more questions about history. ie: pt arrives with CP so the pivot nurse asks if he has a cardiac history. That give that patient a priority triage.
The pivot nurse hands the registration desk the form and the patient is quickly signed in and the name is then in the system and on the screen / dashboard.
We do prioritize triage somewhat. An elderly patient with SOB will be triaged over a 25 back pain. When the patient needing triage gets a little backed up, the pivot nurse assigns 1, 2, or 3.
We have triage teams assigned to 1 of three or four triage rooms. The patient is then officially triaged and given an acuity.
If we have empty beds which only happens in the early morning, the patient goes straight back (generally speaking). If the patient has to wait on a bed, the nurses will drop in a protocol order set and at least get some blood drawn, urine, and maybe an X-ray if needed.
Once the patient is back on a bed and seen by the MD or MLP, the patient is then registered and all the insurance info is submitted.
We have a two-step "quick reg" triage system. When the patient first comes through the entrance there is a desk with registration and a nurse. This nurse enters the chief complaint and assigns an ESI. If there are rooms open, the patient goes straight to a room and the triage is completed by the primary nurse receiving the patient. We use a 5 level ESI system. If there aren't enough rooms for all patients to go direct to a room, 3s, 4s, and 5s get sent to a triage room for triage to be completed by another nurse and then they get sent to the lobby, 1s and 2s still get sent straight back and, again, triage is completed by the receiving primary nurse. Full registration is completed when the patient gets to a room.
In the ER I work, there is just registration and a triage nurse station. Why do they have 2 nurses seeing the same patient??
They register and are taken back for triage based on chief complaint or time (lower priority obviously). They get triaged by a single nurse and either get a room or wait for one. I wouldn't be comfortable assigning an ESI number for the majority without atleast a set of vitals.
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