We have just started having a nurse be the Reassessment Nurse assigned in Triage. We do use a 5 tiered system. But I was wondering if other ER's are doing the same. Are you reassessing the 4 & 5's every 2 hours or are you using a different time criteria for the old "non urgents"?
Input would be valuable as I sense that a lot of staff are very disgruntled and any suggestions would be great as to how other departments are handling this. I totally understand that 2' and 3's should be reassessed q 2 hours but sprained ankles or finger pain for 6 month is hard to justify!
Plus we do have permission to give narcotics in triage under our standing orders (orally only) and so there fore after 20 - 30 minutes of administrating these , we also have to reassess.( which is of course good practice but so time consuming now)
I believe that this is fixing the wrong problem.The processes in the main hospital , lab turn around,s RN 's speed of working etc are the bigger issue .By fixing these things there should hopefully not be patients waiting for 2 hours!
We are also doing ATP-standing orders in triage to move things along. Abdominal pain gets cbc, cmp, amylase, lipase and ua. Cp gets cbc, cmp, trop. flank pain urine dip. Pretty standard to get people moving along. This way labs are already working, and it doesn't make a difference if they are in the waiting room or in a hallway assignment. We are also sending patients who are coughing with temp to chest xray to start PRO just in case-right from the waiting room. True of dopplers for dvt too!
Maisy
Maisy, this might seem like a minor point but do you start saline locks on all those patients, or just do a straight stick for blood? Just curious ... as it's a continuing topic of discussion where I work. The standard practice is to "lock & lab" the vast majority of patients excluding fast track, but your protocol either leaves them in the waiting room with a saline lock or means a 2nd (some might view it as unnecessary) stick.
We don't saline lock the patient-it is a straight blood draw. At the point labs are drawn, the patient's name and condition has been listed. The triage exam has been completed-and the nurse makes the decision like she would out in the ER to initiate standing order protocols.
Saline locks is a standing order, but an invasive procedure. If a patient were to leave LWOB or AMA we'd have a problem. I don't want anyone leaving with my Iv cath! If the patient is on site for abdominal pain or cp and the labs are negative-they may have or will be screened by a PA or NP before actually reaching a room and be discharged with po meds. If a postive trop is returned on a minimally symptomatic or ekg cleared patient they are brought right back and someone is kicked out of a monitored room to a hallway assignment. Usually, they are happy that something was done and don't mind the then necessary iv insertion.
I am not sure about other states, but we are responsible for getting the iv catheters removed prior to leaving-no access is ever allowed. They even d/c ports between our infusion center and our ER which I think is ridiculous! I mean think about it, a sick person needs an IV-I don't know about you guys but we are inudated with cp complaints-everyone thinks that will get them in-so everybody with cp gets those.
I agree with you. I do not want someone sitting in the waiting room with a lock. But there are those who are hung up on the "but then we have to stick them twice" deal ...
I agree with you. I do not want someone sitting in the waiting room with a lock. But there are those who are hung up on the "but then we have to stick them twice" deal ...
That's when I say, thank goodness we took your labs-with an iv I can give you anything you may need during your stay. It's all in the delivery!:nuke:
Wow... We also use the 5 level ESI... But we're lucky if the waiting room patients are reassessed in 12-24 hours...
I think it really depends on how busy the hospital ER is... Because for my hospital, it is IMPOSSIBLE to reassess every patient in the waiting room every two hours, even at 0300... We usually have two RNs triaging and one triage charge RN... The triage charge RN is responsible for looking at everyone already waiting, doing visual assessments, monitoring chief complaints and lining up those who need to be triaged next for the two triage RNs... If we're lucky, we will have three triage RNs, but that's rare... We usually TRIAGE anywhere from 150-250 patients a day only in TRIAGE but we see approx 300 pts a day... I also think they should be reassessed more frequently when they're sitting in the waiting room for a minimum 12 hour wait on average, however it's just not possible at my hospital unfortunately....... There are other people looking at triage assessments in the back, though... We have two sides of the ER: a medicine side for the CVA, MI, chest pain, CHF, dialysis, etc patients, AND a trauma/surgery side for the MVCs, MCCs, abd pain, abscesses, etc... Each side has a charge RN... So there are usually two triage RNs and three charge RNs and one other RN (the position is hard to explain) that monitors the waiting room chief complaints...
But to the ESI acuity level and reassessments: At my facility, there IS NOT a set requirement of reassessments based on acuity, such as 4s/5s need q2hr reassessments... We leave 3s/4s/5s in the waiting room... But if/when we finish triaging all of the patients, we immediately start on reassessments...
oh my goodness! please tell me you are exaggerating when you say a 12 hour wait! what part of the country are you from!?!
I hit the "thanks" button when I meant to hit "quote."
12 hour waits are not unheard of. Please understand that if a patient waits 12 hours ... it was a very non-urgent complaint to begin with.
Once had a symptomatic cp patient who told me we were great, he'd only waited for 5 hours! I asked him where he was from and told me he was from Brooklyn, the average ER wait in his old neighborhood was 24+ hours!
I hit the "thanks" button when I meant to hit "quote."
12 hour waits are not unheard of. Please understand that if a patient waits 12 hours ... it was a very non-urgent complaint to begin with.
I guess I'm just used to the wait times up here in Ontario, usually class I and II are seen immediately , class III within an hour or so and class IV and V within a few hours (3) there are times that people have to wait up to 5-6 hours but thats an extreme. I'm from Canada am I'm so used to hearing about how people in the US get faster service because they pay for it. I guess it's not always the case?
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Altra, BSN, RN
6,255 Posts
Maisy, this might seem like a minor point but do you start saline locks on all those patients, or just do a straight stick for blood? Just curious ... as it's a continuing topic of discussion where I work. The standard practice is to "lock & lab" the vast majority of patients excluding fast track, but your protocol either leaves them in the waiting room with a saline lock or means a 2nd (some might view it as unnecessary) stick.
Just wondering.