Pull until full triage

[Mirnew]

I was wondering how other emergency rooms do triage? We are attempting to do pull until full. We still have an assigned triage nurse, but are having difficultly with what the triage nurse needs to do. Currently we are having the triage nurse do vital signs and take directly to room. The nurses in the back that are receiving the patients feel overwhelmed and that the triage nurse isn't doing enough. We are trying to improve our door to doctor times and need to reduce our times by 8 minutes. Does anyone have any other suggestions or ideas? Thanks in advance!

[zmansc, ASN, RN]

Interesting. Thanks.

[dsherman]

we have 3triage bays in which a doc or nurse practitioner order tests meds,etc and then the patient goes to a room

[Anna Flaxis, BSN, RN]

At my old ED, we had 3 triage rooms, where the triage nurse would hop between the three rooms, getting a chief complaint, a set of vitals and the reg clerk would to a quick registration. Then the flow nurse would take patients back and get them started by doing the med rec, a focused assessment, and starting any nurse initiated protocols, before handing the patient off to a nurse in the zone. This only worked when we had beds available and were not backed up. When we were backed up, the triage nurse would do the full triage, and the flow nurse would be in the back helping discharge patients and turn over rooms so we could flow people back. It actually worked really well because the triage nurse did not have to leave the triage area and had someone to cover their breaks, and if we had a good flow nurse, the patient would be tucked in and everything already started before handoff. Some of the nurses didn't like it because they preferred to pull their own patients from the lobby rather than having patients brought to them, and often complained of feeling like they were having patients crammed down their throats when they weren't ready (but these tended to be the complainers who found a lot of things to complain about). We saw 150-200 daily at our Level 2.

At my current facility we are too small to have a designated triage nurse. We only bedside triage ambulance patients, or those who come in through the lobby with chief complaints of chest discomfort, stroke like symptoms, respiratory distress, etc., where we need to get interventions going immediately. Everyone else gets a full triage at the triage window. 30/day is a busy day for us, we're a Level 4.

[NeoPediRN]

We do the same and the triage nurse will do the computer triage bedside and start the line.