your hospitals triage system

classicdame, MSN, EdD · Mar 25, 2009

Our triage time is very fast, under most circumstances. Our facility is a little larger at 135 beds. An RN does the initial triage, unless it is trauma or chest pain - these go straight back. The triage nurse may refer pt to the nurse practitioner instead of MD, if situation allows. This alone prevents the MD from having to see every runny nose. We get people from walking in the door to cath lab in under 60 minutes.

SummerGarden, BSN, MSN, RN · Mar 25, 2009

Our triage time is very fast, under most circumstances. Our facility is a little larger at 135 beds. An RN does the initial triage, unless it is trauma or chest pain - these go straight back. The triage nurse may refer pt to the nurse practitioner instead of MD, if situation allows. This alone prevents the MD from having to see every runny nose. We get people from walking in the door to cath lab in under 60 minutes.

Outstanding! The ED you describe is the kind of Emergency Room that nurses salivate over! It sounds like your manger runs a tight ship and there is a lot of team work! What model (if any) is your ED following?

ERjodiRN · Mar 26, 2009

we also have very fast triage times. everyone is triaged by an RN and if that nurse gets backed up with too many to triage she calls for a 2nd triage nurse who comes to help out. right now we have 40 acute beds in the main ED and 20 fast track/light medical beds in an area we call 1south, which is essentially our fast track area open 1100-0100 and has 1md and 2pa's. if we hit a 1hr waiting period for pt's who have been triaged to come, we start considering opening our "triage plus". we did this because not only were the triage and radio nurses upset with the long waits (as well as the patients), but the doctors weren't able to see as many pt's as they are used to because they weren't coming back. so we set up an area where we bring 2 pt's back at a time. the doctors see the patients in there and do a cilffnotes version of an assessment. they get labs and tests ordered, drawn, and completed...all while possibly still waiting in the lobby. the blood gets done in the room, then they go back out to the waiting room and get called from there for their xrays, ct's etc. if they haven't gotten a bed in the back yet. it really helps the patients waiting in the lobby so they feel that we actually are trying to see them (plus they get to see that we ARE actually busy in the back). so once the two patients come back, we bring another 2, etc....until things clear up. we have a lab tech dedicated to the room when it's open so there is very little nursing work to be done in there. a big downside is that we aren't able to medicate with anything IV, or any PO narcotic because of assessment reasons. but we're still at least able to get the ball rolling on them.

the 2nd triage nurse is really helpful, because if you have nights where it's backed up like that and you hit the hour mark of waiting....it's time to reassess the pt's already triaged (our hospital protocol). sometimes it's nice to have the 2nd triage nurse out there to do that while you triage the ones still coming in.

whoever is the radio nurse is in charge of pt. flow and will go around and help people discharge or get their pt's upstairs more quickly. every ed seems to have those nurses who hold on to their pt's forever because they don't want a new one! they pester the doc's too......get the fire burning under them to figure out where their patients are going.

the model of triage we use is a canadian one.....which i really really like. i honestly can't remember the name though. good luck!

TeresaEDRN06 · Mar 26, 2009

Thanks! These posts are so helpful! I really like the triage plus idea. :nurse:

GleeGum, BSN, RN · Mar 26, 2009

I am just getting trained to do triage in our ED and we also use the ESI system. We have about 56 beds and our goal is to see each patient for about 2-3 minutes, assign their level and location, and send them on their way (we have 4 areas: Peds, Fast Track, Critical, and Acute).

It's hard to tell the level 3-5 patients that there is a wait. And that wait could be several hours. But you can't have a truly sick patient waiting to get triaged, because you are right, that is scary!

GleeGum, BSN, RN · Mar 26, 2009

Also, we have 1 or 2 nurses doing triage depending the time of day, plus an ambulance triage nurse who holds the radio. And the most we do in triage is an icepack or a bucket - no IV's though!

KNARE · Mar 26, 2009

We operate much like ERJodiRN's facility does. The difference is we have a doctor in triage from 12n-10pm. We use the ESI triage system. The triage team is 1 RN, 1 Medic, 1 ED tech and the MD. We do EKG's, draw blood,aerosols, send pts. to ultrasound/x-ray from triage. We also do not medicate in triage which is a dissatisfier. We discharge the dental pains, medication refills, ear aches, etc. right from Triage. Our biggest problem is the number of "Boarded" pts. in our ED..... doesn' t leave much room for the true ED pts. Our average door to balloon time is under 60 min. and we've had several squad pts. who have hadd a 15 min. door to balloon time... (the ED doctor will call the Code STEMI based on the transmitted EKG from the squad) Everyone really likes having a doctor "at the door" It helps the triage team and has increased customer satisfaciton. The triage MD also sees the squad pts. when able to, does a quick assessment and enters orders for these pts. Sometimes the doctors do not agree amoungst themselves... "why didn't you order ?????" That's kind of interesting. The bed / boarding pts. situation.... that's another issue in itself!!!

FlyMurse, BSN, RN · Mar 27, 2009

I work at a level 1 trauma center, so we have essentially 3 different ways to get pt's back:

1. if EMS patches and the trauma team decides to take it, they'll go straight to our 5 bed trauma room. If the triage nurse decides the pt may need trauma, an MD has to upgrade them if they are a walk-in.

2. Pt's walk in, get registered then seen by our triage nurse and tech. We get a baseline set of vitals and provide simple things like bandaging wounds, blood sugar check, ice packs and EKGs. (Our goal is door to EKG, 5 mins. Door to baloon, 60 mins). Pregnant females over 16 weeks go upstairs to OB triage.

-from here, the nurse either sends the pt back to our Intake room (another waiting room)

-or calls charge nurse to ask for a bed.

Intake nurses finish the pt's triage, send the chart to a doc who sees the pt, orders tests, procedures, medical imaging, etc. The pt's then go to "continuing care", formerly "results waiting" where the RN waits for results, and tech checks vitals every 1-2 hours.

After the results are back, the doc re-eval's the pt, and from there discharges or admits the pt.

Meanwhile, pt's in our acute areas get similar procedures, the only difference is they are in a bed and their doc only manages 10 pt's at the most (we have two 10 bed acute areas for high risk complaints and ambo's). The majority of these pt's are admitted, but some of the BS ones that fooled the triage nurse are discharged.

Good Sam ER at a glance! haha

Jeremy

Editorial Team / Moderator · Mar 27, 2009

We have 15 beds, one triage nurse, and use ESI. We're a freestanding ED, so no hospital resources -- we're it!

TeresaEDRN06 · Mar 27, 2009

Thanks so much guys! Your responses are so helpful. One more question. At what point do you take the initial vital signs? When they first walk in? When they sit with the triage nurse? (even if that's an hour or more later?)

Thank you!!!

Teresa:heartbeat

ERjodiRN · Mar 27, 2009

once i call a patient in to the triage booth i have them sit down and start getting their vitals right away, all while talking to them about their chief complaint. when it comes to people who have complaints of sob, palpitations, stroke symptoms.....vitals are important. that sob might have a low spo2 even without obvious signs of resp distress and barely a change in their skin tone. the palpitations could be in rapid afib or svt. as the triage nurse you have the right and responsibility to change the order in which you see the patients that come in. i'll have 10+ in the rack to be seen, but we have a tech out there who gathers the chief complaints and will alert us to the more acute complaints. i'll def want to see them before the hurt ankle. when it comes to people in obvious resp distress, aloc, cp, trauma....they don't even get vitals....they go straight back whether there is an open bed or not. we have a critical care room (ccr) where we run the codes that come in from the field....much like a typical trauma bay. we use that room if we have nothing else, or pull someone stable from a room to the wall and use that. it may not be a bad idea to get the vitals as soon as they walked in. it's just a matter of staffing. we have a registration person, a tech, and the triage nurse. the tech meets the people and gives them the slip to fill out their chief, or instructs them straight to the booth if there is no one waiting. the bus always seems to unload when we get people walking in....so rarely is it ever just one person. so we couldn't have the first person getting their vitals done by the tech as the rest stand their waiting just to fill out the chief form. we don't have enough staff to have someone strictly for vitals. again, when it fills up i just call the 2nd triage nurse to help so that people are seen within 10min after walking through the door.