edrn091414

It sounds like the OP works at my new job :-/ I have the same problem, and I had a sentinel event just a couple weeks ago. Our ratio is 5:1 so when I got two patients within 10 minutes of each other I prioritized. I had a diff breather on bi-pap and a man who was petitioned by PD for cutting his wrists (bleeding controlled, already scabbed). I left the suicidal pts room for the new ambulance, but not before calling the house supervisor and asking for a sitter (told that they don't staff for sitters in the ER but she would try to call one in). While I was triaging the bipap patient the suicidal one ran out of the department. Nobody noticed...he was three blocks down the road before police caught him. Fortunately he hadn't done anything while he was running. I sat down and talked to my manager that day, told her that this was so dangerous. I wrote it up in the hospitals risk management system and everything. It's been several weeks and I've heard nothing from anyone about the matter. I guess it wasn't serious enough to warrant any change, apparently we'll wait for somebody to hurt themself.

Also what's the RN to pt ratio where you work? Because I feel like not doing a full triage and having a high ratio is really hurting patients. Just curious what the ratios are other places that triage fully or that pull to fill

Skylark I agree 100% as having seen a patient complain of horrible sharp upper abd pain, get triaged a priority 3 ESI and then get back to me where I get her full medical history and see she's hypotensive with a history of AAA. Now if she would have been properly triaged with vitals, history, home meds they would have got her back right away. Instead she sat in the waiting room for 45 minutes. Stories like this just pile up every shift I work, I just really need concrete evidence to bring to management that compels them to change before people like her die in the waiting room.

Op- I just started at a new hospital also and I you sound like your describing this new job. I came from two other emergency departments who both did full triage-vitals, EKG, history, etc. this practice of assigning an ESI number with little if any information is terrifying and not just for the RN in triage. As a nurse in the main ER I get patients brought back and I have no information on them. If I can't get into see them right away because of other critical patients or ambulances they sit in my room. I've always practiced under the understanding that as the primary RN I'm responsible for the patients in my room. This triage system plus having 5 patients to one RN all priority 3 and up is so dangerous. Does anybody have any evidence or research that can be brought to management to help change this practice. We all know it's unsafe but I need the best practice research to actually put enough pressure to make any changes. Thanks! And I totally feel your pain OP.