New triaging system...

Obviously unsafe to have that many patients and only 1-2 RNs having ALL of the patients in the ER. What happens if someone codes? You don't have a code team. Or a patient triaged as a 4 (stable) ends up having a STEMI? There is a lot of room for liability issues here.

Where I work, we take a max of 4 patients per nurse. If we're short on nurses, we close off rooms. We're our own rapid response and code blue team. Very rarely do they announce a code blue in the ER on the overhead pager system.

The only code team we have are the ER nurses (2-3 total depending on what time of day). This new triage policy was put into place to increase press ganey scores. The idea behind it was to reduce LWBS and increase patient satisfaction.

The only code team we have are the ER nurses (2-3 total depending on what time of day). This new triage policy was put into place to increase press ganey scores. The idea behind it was to reduce LWBS and increase patient satisfaction.

The triage portion, yes, I can see how that could improve satisfaction scores...but afterwards, whether they're in the waiting room or the ER, will definitely be a problem with only 1-2 RNs and up to 18 patients each. It's ridiculous, IMO, including those stupid Press Ganey scores.

While that is indeed an unsafe nurse-patient ratio, there is also liability in not having a triage-trained nurse at the front door to immediately triage a patient. I hesitate to ask ... how long were some patients (who appeared "ok") waiting for triage before the implementation of the new process?

That's pretty similar to how we do it in my little ER. We are 17 beds, one triage nurse, one supervisor, and 2-3 staff nurses that are scheduled staggered throughout the day. Triage nurse quick-regs patients, triages 99% of all pts through the door, EMS and walk-ins, assigns rooms, places on monitors, changes clothes and medicates fevers etc w/ verbals as needed. Staff has 4-5 pts each, sometimes more, depending in how many pts are in and what time it is and what staff is coming in when. We close off rooms if possible until we have the staff to care for them. Nursing does all their own labs, EKGs, nebs, etc, except on weekends when we have an EKG tech. We do have an Aide, who helps with v/s, cleaning beds, stocking, bathrooms, changing clothes, applying monitors, etc. She is a big help! It helps that we work as a team pretty well.

We usually use our nursing judgment and we normally get the patient triaged and to a bed quickly. However, there are times when we have an ICU/critical patient that it takes both nurses or all three nurses to get stabilized and ready for transport to an ICU 30 mins away. My problem with the system is that they not only want them triaged immediately, but also placed in a bed immediately. "Door to doctor in 10 minutes". How they have remedied that is to take one small exam room and cram 10 chairs in there and have us treat ESI 4 or 5s in that room. No privacy at all. They also require us to radio the doctor on a walkie talkie and have him examine the patient right there in the triage room. We have only 1 doctor who works 24 hr shifts, 2 nurses from 7a-7p and 2 from 7p-7a, and a midshift from 10-10. No aide, no clerk, no housekeeping, we do our on blood draws, ekg's, respiratory, bed baths, trauma and critical care, etc. Before this policy, truly emergent patients went straight back to a bed and were triaged and treated in the bed, all other patients were triaged and roomed immediately and treated as well, unless a bed was not avail, then they were triaged and placed back in the waiting room to wait for a bed (esi 4s or 5s), but a nurse also checked them every 15 mins.

If you have only one doctor there is no way...Ten minutes leeway before they have to see the patient. What if they're sterile in a procedure? Or interviewing another patient? Basically admin is saying the doc can take no more than 10minutes on any task, because someone might need assessment. Cutting people off has its own patient satisfaction risks. If only they could leave the waiting time to staff judgement. If they find people goofing off while patients are waiting, that's another story, but it doesn't sound like you have the time.