how does your er triage?

[Uptoherern, RN]

If anyone has seen a thread re: this, please let me know. I did a search, but couldn't find anything.

My question is......how does your er triage? Our goes like this......

(I'm talking about walk=in patients in the lobby only) The first thing a patient sees are the registration clerks. The patient is told to fill out a form (name, dr name, bday, reason for visit, etc) then gives it back to the clerk. The clerk then puts the pt. in the computer where we can see name, age, reason for visit, and how long they;ve been in the computer. The clerks will tell us if someone seems esp. ill (bleeding all over, laying on the floor, gasping for breath...) whatever. We then have an area that we call patients over to and triage them there. If someone IS really ill, we take them straight back (hopefully we have an open bed), and triage them back there. If we are able, we triage in order of arrival (with the exception of the ill people), then take immediatley to a room or return to waiting room to await open bed.

ok.

We are being told that we are the only ER that does triage this way. (Mgr). We are being told that our triage system will change. Which is ok with me if it works....... We are told that in most ER's, the first person a patient has contact with is not a registration clerk, but an RN.

Please.........tell me how your triage works. If our triage nurse is going to be a meeter and greater, how is she going to be able to triage? We are told that we need to keep an eye on the waiting room door and watch what walks in. If I am triaging, I am watching the pt. I am triaging, not the door! I am also not sitting there the entire time, as I am constantly going to the back and to fast track to take pts to their rooms. I don't see how I can watch the door, if I am not there.

please let me know what you guys do for triage. The only solution I see is to have 2 triage nurses.

We see approx. +/- 100 patients per day.

thanks

[EDAriRn]

erdiane,

In my ER the first person to see a pt is the nurse. It sounds like we use a system that is similar to what your manager is going to switch to. When the patinet walks in the door they fill out a form with general info (name, time, PCP, and cheif complaint) and are called to be triaged by the triage RN based on time of arrival and accuity. I agree that it is tough to have to play greeter and handle all of the visitors and do your triage, but I think that there are merits because a lot of the time I notice that the CC is not the reason the pt is actually there and having an RN to sort it out helps. I would say that we see at least that many pts on a normal day and this system seems to work.

on a side note, i'm from cleveland and have been thinking about doing travel nursing, and phoenix is high on my list. what do you think of it out there, how are the RNs treated, is the pay good? any advice you have would be appreciated.

Thankx

[Katnip, RN]

In our Ed the first person the patient saw was registration. Much like what you're doing now. So no, you are probably not the only ER that does that.

[KristyEDrn]

I am an ED RN in NC and I have worked at several hospitals here, only in triage in 2. The first place the pt was met by a greeter and it was in a spot where the RN could see but didn't have to acknowledge. It worked great b/c I didn't have to give directions, explain where outpt was, tell them where their friend/family member is located and then "beep" them back, etc. Where I work now, the triage RN does all of that and triage. It is extremely annoying to be interrupted a million times to say "Do you need to see a doctor? Then fill that card out" or "Then have a seat and I will be with you in a minute" or whatever...There is no privacy for the patient when the triage RN is having to also direct traffic.

[Uptoherern, RN]

we use lots of travellers in phx. mostly during the winter months because A. We are the busiest then, and B. you DO NOT want to be here in the summer. It starts to get hot in May (>100 degrees) and stays hot until around the 3rd week of October. If you like hot, I guess it is ok. The hottest day we had here was 123 degrees. Airplanes weren't allowed to take off or land because charts for wind currents didn't go up that high!

Overall, nurses are paid rather well in phx, esp compared to the southeast it seems. There is lots to do. mountains in 3 hours, san diego in 6, mexico in 4..........

[Uptoherern, RN]

as for the previous post on er triage, how do you comply with Hippa if new patients are asking you questions while you are triaging? that doesn't seem like it would fly at all.

As triage nurses, does anyone circulate IN the waiting room, asking people why they are there, etc? We call people back to triage for 2 hour vitals and reassess, but generally don't wander around the waiting room. If I triage as fast as I can, I still fall behind no matter what. I'm geussing we will find out what is in store for us over the next few days. I still don't see how the patients will be greeted by me first, instead of the registration clerks. I don't see how I will be able to do that timewise. maybe if they cut out some of the things we need to do? right now we do 0-10 pain scale (come on people, just give me a #! it's amazing how many people can't decide!) we are required to get height and weight, current problem, full set vitals, allergies, meds, surguries, med problems, smoke?, drink? Live w / any one to help you if you need help after d/c? then about 6 ?'s re: tb. LMP, gravida/para/etc., immunizations, td. Of course some triages take forever, and some are quick. we then print dr. order sheet, triage summary, dr assessment form (pertinant to whatever complaint pt has.......mva, neuro, uri, asthma, chest pain etc), and we print the nurses notes.

point being, are we doing more in initial triage than other places?

[KristyEDrn]

As far as HIPPA goes...I do not think pt's are given the privacy they need in our triage.

As far as doing too much...we do what you do minus printing out the paper work. We used to do that but recently stopped which makes it nice b/c that is ONE less step! The only time it is printed off is when an admitting doc comes down and wants to see what all was done/etc. We are computer charting.

[ERNurse752, RN]

We strictly follow the guidelines given to us by Good Housekeeping

[neneRN, BSN, RN]

In our ER, pt is seen first by a tech, who takes their VS and has them fill out reason for visit, name, address, DOB. If VS are abnormal, the tech gives the chart to one of the triage nurses; otherwise it goes into a pile as they come in. If the pt is very unstable, the nurse can have the pt walked to the back without triaging, and then the nurse in the back who gets the pt will triage.

We have 2 triage nurses, and a third for busiest hours. The nurses each have their own little office to triage in directly behind the tech, so visitors and pts aren't able to get to the nurse unless they're let through. We also have a designated visitor control person out there who handles letting all the visitors through.

Once the pts are triaged, the nurse determines if they meet "walk back" criteria, meaning they get sent directly to a treatment room. If they do not, then the chart gets sent to the charge nurse in the back, who keeps all the charts of those waiting and brings them back as spaces open up.

[Uptoherern, RN]

HOW many patients does your er see? per day?

In our ER, pt is seen first by a tech, who takes their VS and has them fill out reason for visit, name, address, DOB. If VS are abnormal, the tech gives the chart to one of the triage nurses; otherwise it goes into a pile as they come in. If the pt is very unstable, the nurse can have the pt walked to the back without triaging, and then the nurse in the back who gets the pt will triage.

We have 2 triage nurses, and a third for busiest hours. The nurses each have their own little office to triage in directly behind the tech, so visitors and pts aren't able to get to the nurse unless they're let through. We also have a designated visitor control person out there who handles letting all the visitors through.

Once the pts are triaged, the nurse determines if they meet "walk back" criteria, meaning they get sent directly to a treatment room. If they do not, then the chart gets sent to the charge nurse in the back, who keeps all the charts of those waiting and brings them back as spaces open up.

[neneRN, BSN, RN]

Last year we saw 116,000. This is our busiest time of year, so right now 300-400/day; less in the summer.

[Uptoherern, RN]

i guess that would explain the three triage nurses. sounds like our county er. I believe I will find out tomorrow how our triage system will change. I don't particularily have high hopes, since all of our recent "changes" have involved more work, imo, for the nurses.

still would like to hear from others the process they use from initial patient contact to end of triage process.