I see what you are saying, Rhia. In terms of what a pt comes in "saying" is a yeast infection, I would triage her a level 4, with my reasoning being that in our facility (not sure of others), she WILL be getting a pelvic and since they're doing the pelvic, they will be doing a GC/Chlam & wet prep, which constitutes one resource. I would also send this woman to fast-track (unless closed). Stuff like that is obviously harder to triage since you obviously can't SEE what is going on in your triage booth, and are basing it on subjective and objective info. Some providers in our ER may just do a quick pelvic and not send labs, but in fast track, they figure as long as they are down there they might as well culture it.
I work triage for 7 hours of my 12 hour shift (long explanation, but I work 1p-1a, and work as second triage nurse until 8, then move to either ER or fast track. If a 2nd triage RN is not needed, I'll work as float in main ER with a pt assignment until needed in triage or fast track. It's a crazy way to work, but I love it!), so I've gotten pretty comfortable with what PA's and MD's are working and what I know each will "work up" and what they'll "treat & street". That said, I hardly ever triage anyone a Level 5. Usually only med refills (although must say I got BURNED a few weeks ago with one pt that came in looking for HTN meds. Turned out she actually had IVC papers taken out on her and it became a big mess!! Not that I knew, but still, I felt bad that Fast Track had to deal with that) and the FF that comes in with a recurrent complaint I know they won't work up, but even still I may make it a 4.
And since we are more and more sending off urine to the lab, even the simple UTI sx gets a level 4 (no point-of-care for urine - except UPreg - in our ER, which really chaps me. It's just as easy for us to dip a urine as it is for the lab, and quicker results. It can always be sent off if needed) since we have to send to lab.
Once I get to Level 3 and above, especially with c/p, it can get more tricky. I know MANY nurses that make ALL c/p a level 2, no matter what, even if it seems muscular or may be from a chronic cough. C/p and CVA sx are ones that you REALLY need the ESI "danger" vitals and a good hx. If there is ANY kind of cardiac hx, or hx of current drug/cocaine use, they're level 2, and if I don't have a bed, I start a cardiac work-up according to our protocols. If it's a guy that had been moving furniture and having c/p, can be reproduced, no health probs or hx, I'll still do an EKG and have the MD sign off on it (if no beds), but would feel comfortable making him a Level 3 if EKG is okay.
Those ones are the most tricky, and especially with women. I "go with my gut" on a lot of the women with c/p in their 40's and 50's, especially when they say they have GERD and "some stomach upset". I've seen too many women having STEMI with vague sx like that.
I'd love to know how others will triage c/p and CVA sx. I really dislike that our registration can even USE a term like CVA Symptoms when quick-registering before they come back to triage (this is if we're full, which is most of the time. If a bed is available, they go right back, don't get me wrong). I know they have to use something, but a lot of times I will end up changing that term so it doesn't look like the chronic migraine FF is sitting in the WR having a stroke!
We are having EVERYONE who triages in our dept re-take the ESI course every 2 years, which I think is a good idea. I've worked some places that demand every c/p is a level 2, and some places that don't. It's good if we're all on the same page with that.