Has anyone else's triage changed.

[JessicRN]

Has anyone else's triage changed. We used to have a triage nurse a 3 bed express unit run by an MD and an LPN. New management came in and has recently changed it we no longer can say we have triage but Rapid assessment . Now we have a greeter (usually a non medically experienced person) who short registers a pt (name and medical record number) then we have 2 RN's and a 5 bay rapid assessment.

The greeter puts the patient in one of the rooms and puts the chart in a rack by time only. In theory the RN is supposed to see a patient triage them if they are a ESI 4 or % they stay with us If they are a 4or 5 they go to the main ED. If the main ED is busy we keep the patient and start everything until they have a bed for the patient. The goal is NO ONE STAYS IN THE LOBBY. If there is no rrom in rapid assessment but there is room in the pediatric area a nurse goes there with the pedi and triages in the room.

Sound good so far? When you triage we have to do a full set of vitals including BP's and weight on every patient which for peds can take forever. You also have several patient you are getting meds for or doing lab or IV Xray or taking patients to xray etc (basically taking care of the nonurgent patient who stay with you until discharge or the pt who are awaiting beds.)

Here is the problem the greeters have no medical knowledge and hardly speak or write english,so they might write on cheif complaint, need EKG or for a baby, Coff(cough). When you go to the room which could be 15 minutes or more you find a guy having an active MI who was sent from his doctors office for an irrecgular EKG (it was only showing flipped T's when the patient left the office) or the baby was in respiratory distress with an O2 sat of 85. (these are not hypothetical but what reallly happened. We cannot see any of the patients if they were in the waiting room or come in either, there is a closed circuit camera at the nursing station in front of the secretary that shows the pt come in or sit down in one section of the waiting room otherwise there is a huge blindspot and all the windows to the waiting room have been curtained with heavy funeral parlor looking drapes so we cannot tell what is going on in the waiting room unless we physically go into the room itself.

This is only the system between 1000 and 2200 pm. The hours between 2200pm and 1000am the secretary is supposed to notify us that a pt has arrived or anyone who hears the bell (there is a bell heard at the desk and nursing station) that goes off whenever the main ED door is opened. There are only 3 nurses on the floor duing those hours and it does not matter how many patient we have as we can't go on divert.

Is anyone else's triage like this or close?

[Okami_CCRN, BSN, RN]

I think the idea of no one waiting is good but the implementation of it is not... safe or practical by any means.

Our ER triages as so... patient walks into lobby and goes to security personnel that take complaints and logs them into the computer. We have two nurses in Triage Booth 1 and 2, they will either give the patient a priority 2,3, or 4. If the patient is a priority 4 they will be seen my fast track and a 2 or 3 will go to the Main ED when room is avaliable. Also in the booths EKG's are done on patients with chest pain or anything that may need an EKG. The patient is then either sent back to the waiting room to await treatment/registration or sent immediately to the main ER to recieve treatment/registration.

[lpnstudentin2010, LPN]

At the hospital when I am a patient this is how you do it.

You walk in the the registration desk, tell them what your complaint is, and get a braclet. You are then sent to the waiting room.

Triage nurse calls you and you are seen in triage. You are sent back to the waiting room.

Then you either go to fast track or the main ER. Since I am just a patient I do not know what the difference between them is, but I know there are the two of them.

[xos4eva]

I work as a nurse in a pediatric emergency room and more often than not I'm in triage. We don't have a fast track for pediatrics but our system is as follows, we have pages numbered from 1- whatever. On the page we ask, pts name, parents name, time and reason for their visit to the ER. They are to then place the paper in a box. I pick up the papers and keep them in number order. i will look at complaints and try to prioritize according to complaint even if it's out of number sequence. For example, I will take a psych pt, who is at risk for running out or an asthma pt over a pt whose complaint is fever, though I will assess the fever if the child is feverish looking, crying, etc...... In traige I get a full set of vitals including height and weight. If there is fever I medicate with tylenol/motrin. If there is pain I medicate with tylenol/motrin. I'm not allowed to draw labs in triage but if there is chest pain or etc I sent them to the back for EKG or blood work. After traige ESI levels are assigned, the pt registers and the Doctors call them in. Can things fall through the crack heck yeah. Effective, not so much

[JaxNewGrad]

My only triage experience came during clinical rotations at school. I was appalled when I realized that the person who checked in potential patients had no medical/nursing or triage training. (The misspelled chief complaints should have been a red flag sooner.) I saw a lot of patients whose complaint sounded minor on paper, but when I decided to do a quick assessment in the waiting area that complaint was often much more serious (e.g., back pain is actually a narcotics overdose, heartburn is an M.I.). This system was consistent among the hospital EDs I visited.

I understand some EDs have patients self-triage by way of a computerized software package located in a kiosk at check-in. I wonder how well that system works?

[Okami_CCRN, BSN, RN]

you mean that the people at the traige both are not RN's!?!? At every ER I have gone to the person in the Traige booth/room is an RN. Yes some places have a computer where you sign in. for example "Name: John Doe, DOB: 1/1/01, Complaint: fever, please be seated until your name is called" but never for triage