Rickbos

We used to use pagers but 2 or 3 times a day I would "beep" the next patient and wait & wait & wait, and "beep" again ....but nobody would respond. I swear someone's garage door in the neighborhood was opening and closing instead.

Its all determined by total amount of resources utilized as outlined in Emergency Severity Index Version 4: Everything you need to know 5 LEVEL TRIAGE SUMMARY ESI 1 Needs life saving interventions ESI 2 Needs immediate Rx but not life saving Rx ESI 3 Needs 2 or more resources but not a level 2 ESI 4 Needs 1 resource ESI 5 Needs no resources other than physician exam DEFINITION of RESOURCES Lab, EKG, x-ray, IV Fluids, IM/IV/Inhaler Meds, = 1 Resource Consult with Specialist,Simple procedures i.e.; suturing, ear/eye irrigation, DSD change, splinting/casting etc.= 1 Resource Procedural Sedation = 2 Resources What is not a Resource Finger stick BS, Urine Dip, Saline Lock, oral med, Tetorifice, PCP consult CRITERIA For ESI 3 Upgrade to ESI 2 ...........................Pulse ..Resp.. SO2..... Temp 100.4 180.. >50.. 100.4 (? Consider) 3 months- 3yrs.........>160 ..>40.. 102.2 (? Consider) 3 yrs-8yrs ...............>140 ..>30 .. >8yrs .....................>100 ..>20 ... Valid pain >7/10 if pain unresolved through triage intervention i.e. ice elevation tetracaine etc.

That is exactly how I feel about the safety aspect of having the charge nurse do triage and have a patient assignment. It is a set up for a bad outcome. Thanks for your answer.

Thanks....

Hi Does anyone work in an ER where the Charge RN is responsible for the whole ER for their shift, triages all patients, and also has a patient care assignment in the ER? If so what type of patient load do they take, how many patients a day does your ER treat, and how many staff RNs are there on duty besides the Charge RN?

Do you, as an RN, have to enter the patient name, DOB, ER doctor, and print out an ID bracelet & stickers as part of triage as part of your electronic triage?

We were proposing the patient upon arrival(if well enough to do so) fill out a carbon less copy triage form that has basic demographics(name, DOB, complaint, & med list). One part of the carbon less copy goes to registration and the other goes with the patient to triage . The registration staff would create a face sheet, patient labels, and an ID bracelet, while the patient is being triaged. The rest of the registration is completed in the patient's room. If the patient is not well enough to be seen in the triage room, everything s done in the room.

We are trialing a new triage system to hopefully improve flow that has the triage RN do a portion of the patient registration, apply the ID bracelet, do the triage assessment, and then place them in a room after triage(if available) and the registration process is completed by clerical staff. Do any of your triage procedures involve the triage RN doing patient registration, or is that done solely by the ER registration clerks? The triage RN feels it slows down their clinical assessment and it would work more efficiently if the ER registration clerk did a "mini" registration for arm band, stickers, and a face sheet with demograpics, simultaneously while the RN was triaging the patient. What do you do out there?

We must have upset some folks in the front offices because we never heard a word from any of them on ER Nurses Day..... Amazing, life goes on!

We use a patient generated triage form that has Name, DOB, Reason For Visit, PCP, Meds & Allergies. Because we are in a resort area, we ask for a telephone # they can be reached at while they are visiting so we can contact them if follow up is needed. This is signed by the patient, giving the patient some ownership in supplying accurate information, and is used as the med recon sheet as well as to aid with the registration process. PMH is not part of our triage form. We are not fully computerized so this is very helpful for initiation of treatment.

Somehow the emphasis with ER care has been put on giving the patient the "false sense" that they are getting treated better by rushing them back in to a room in the shortest amount of time regardless of their acuity. It is an attempt to increase Press-Ganey scores and in my opinion, this flies in the face of "real" triage. If a patient is triaged properly, they will get back to a room immediately if they need it, if not, they will go to the waiting room and go to a room when it is available and the ER staff in the back deems it "safe" to bring them back, not just because a room is available. This concept of "immediate bedding" seems to defeat the purpose of triage. If you fill up all the rooms on a "first come first serve" basis, regardless of acuity, what happens when you need a room for an emergent patient? Valuable nursing time is wasted moving a patient that could have been in the WR out, so you can move the sick patient in. Triage was designed for a purpose and we seem to be ignoring that purpose to get better PR.

The Press Ganey pacifying "immediate bedding" management idea violates the original concept of triage.... "treatment as per acuity". If you want "first come first serve" go to the deli counter or McDonald's. If you want sound, efficient emergency care, utilize an accepted ESI system. "Immediate bedding" should not be done in ERs. The only thing it may accomplish is to give the false sense of being seen faster. It actually can delay treatment of high acuity patients that come in after you fill all your rooms because now you have to throw someone out, who didn't need to be there originally, to get the sick patient in. So Dr Press & Dr Ganey, how is that therapeutic for that high acuity patient? "Immediate bedding" is nothing but a PR gimmick and is detrimental to the delivery of efficient emergency care.

You are experiencing a lull because all your patients are summering in my ER on Martha"s Vineyard. Please put a return address on your folks so we can send them back to the correct point of origin when they are done here. Have a great summer, where ever you are.....

After watching the the 5 Level Triage DVD a couple years ago I made up this little cheat sheet to help me remember the ESI levels. This is solely based on the instructional dvd and really the 5 levels the author of the original question uses are right on. Hope this is of some help to you....Rick 5 LEVEL TRIAGE SUMMARY ESI 1 Needs life saving interventions ESI 2 Needs immediate Rx but not life saving Rx ESI 3 Needs 2 or more resources but not a level 2 ESI 4 Needs 1 resource ESI 5 Needs no resources other than physician exam DEFINITION of RESOURCES Lab, EKG, X-ray, IV Fluids, IM/IV/Inhaler Meds, Consult with Specialist, Simple procedures i.e.; suturing, ear/eye irrigation, DSD change etc.= 1 Resource Procedural Sedation = 2 Resources What is not a Resource Finger stick BS, Urine Dip, Saline Lock(must administer fluids to qualify for a resource), oral med, Tetorifice, PCP consult CRITERIA For ESI 3 Upgrade to ESI 2 ************ Pulse Resp SO2 Temp 100.4 180 >50 100.4 (? Consider) 3 months- 3yrs >160 >40 102.2 (? Consider) 3 yrs-8yrs----- >140 >30 >8yrs---------- >100 >20 Valid pain >7/10 if pain unresolved through triage intervention i.e. ice elevation tetracaine etc.

Thanks for your ideas. Since I posted the original message I have worked it out our ER registration folks to register the patient in a timely manner to eliminate the problem I originally had. All is well for now...thanks