Self Triage

Katnip, RN · May 11, 2005

I never heard of self triage. I'd imagine even for our fast track it would be a nightmare. EVERYBODY thinks they should be at the top of the list, no kidding.

Could you explain how it works? I'd really love to know.

blufoxtrot · May 11, 2005

We don't have a self triage for our fast track. Everyone goes through the same triage. Be aware of the laws. Where I work a nurse must see the patient prior to any insurance information or even name and address being asked by our admissions clerks. Most people coming the the ED truly think they are an emergency and some even get offended when they find out that they are being seen by our fast track nurse practitioner and nurse.

MoodyButt · May 11, 2005

The idea that was given to me this morning was, as patients enter the ED, there will be a sign stating ( something like this): Patient who are here with coughs, colds, sprains, strains, earaches, minor complaints may be seen in FT, with directions to the FT entrance. This is allowing patients to make the decision if they fit these problems. There will be a separate triage area/nurse who then will make the final decision. One of our biggest problems in patient flow is back up in the triage area. We currently have 3 triage stations.

Thanks for your input.

Katnip, RN · May 11, 2005

Unfortunately, I've seen very few people who would say their complaint is minor, even if it isn't. And a lot of people who come in with seemingly minor complaints until they get triaged and find out it's pretty serious.

I think I'd just vote to see if you can get a fourth triage nurse up front and a couple of techs to do the vitals before they're seen by the nurse.

MoodyButt · May 11, 2005

We are locked for space. The front has just been remodeled, with the 3 triage areas. We are currently looking at plans for our new ED, to hopefully be opened in 2008 with approx. 100 beds. This is something we are just tossing around to help for the next 3 years.

CHATSDALE · May 11, 2005

i don't knw about self triage..but i do like the idea about the triage nurse who can question pts when the come in . you don't want someone with chest pain sitting there

waiting to give insurance info..

somepeople at stotic and down-play their sx and you have others who sceam like a banshee w/a broken fingernail

my son had a bleeding ulcer and when he was in a bathroom puking up blood the housekeeping guy went into the nurses station and told them and they came out and took him to the back immediately and insurance nurse came back there to get his info

he is in a constant state of denial...[i AM A MAN, ONLY WOMEN GET SICK]

rjflyn, ASN, RN · May 11, 2005

Your plan as noted below probably isnt going to fly as far as EMTALA is concerned. Once someone presents to the ED a medical screening exam is required. Having a sign telling someone to go elsewhere is probably putting the hospital on shaky ground.

As far as back ups at triage the problem I see is people sign in and then dont see a nurse until she sorts through the names and decides who is the sickest by what is written.

One University hospital I recently worked at had changed its triage system to where the first person one sees as they walk in the door is a nurse. The pt get "triaged" as to level 1-5, with 1's and 2's ( CP, MI, DIB severe trauma, ect) going right back to the treatment area. This typically takes less than 15-20 seconds per patient. After this the patient sits in the triage area and the 2 or 3 other nurses assigned to triage do the further assessment of the 3-5 patients ie vitals, meds, allergies ect. These pts level of severity can and often do change up or down based on the further information. It is also rare that anyone in these lower classes get upgraded in level 1 or 2.

Rj:rolleyes:

The idea that was given to me this morning was, as patients enter the ED, there will be a sign stating ( something like this): Patient who are here with coughs, colds, sprains, strains, earaches, minor complaints may be seen in FT, with directions to the FT entrance. This is allowing patients to make the decision if they fit these problems. There will be a separate triage area/nurse who then will make the final decision. One of our biggest problems in patient flow is back up in the triage area. We currently have 3 triage stations.
Thanks for your input.

mommatrauma, RN · May 11, 2005

Your plan as noted below probably isnt going to fly as far as EMTALA is concerned. Once someone presents to the ED a medical screening exam is required. Having a sign telling someone to go elsewhere is probably putting the hospital on shaky ground.
As far as back ups at triage the problem I see is people sign in and then dont see a nurse until she sorts through the names and decides who is the sickest by what is written.
One University hospital I recently worked at had changed its triage system to where the first person one sees as they walk in the door is a nurse. The pt get "triaged" as to level 1-5, with 1's and 2's ( CP, MI, DIB severe trauma, ect) going right back to the treatment area. This typically takes less than 15-20 seconds per patient. After this the patient sits in the triage area and the 2 or 3 other nurses assigned to triage do the further assessment of the 3-5 patients ie vitals, meds, allergies ect. These pts level of severity can and often do change up or down based on the further information. It is also rare that anyone in these lower classes get upgraded in level 1 or 2.
Rj:rolleyes:

RJ, I don't see it as an emtala violation, they are still getting a medical screening...and when he says shows them directions to their Ft area...I don't think it means leaving the hospital and going to another place...many hospitals have separate waiting rooms for their main er patients and their fast track patients...Also, I don't necessarily agree with that 10 second level triage...Not everyone with CP is having an MI and needs to be brought right back...and not every one having an MI has CP and may sit out there because they are having N/V instead...I think a patient can't be leveled until full triage is done...

Katnip, RN · May 11, 2005

According to EMTALA triage does not count as medical screening. Triage is just that, sorting people out according to acuity. The medical screening happens when the doc, PA, or NP sees the pt.

That's why a triage nurse can't tell a pt that their broken acrylic nail is not an emergency and to see a manicurist.

MoodyButt · May 11, 2005

The patient will still be triaged by a RN prior to registration/physician, assigning a triage priority 1 - 5. It's just we are looking at letting the patient decide which triage area they will start. We will not be sending them elsewhere, our Fast Track is located within our ED.

If the patient choses to come back to FT triage to be triaged and doesn't meet the criteria to be seen in FT, the patient will be escorted back to the main ED waiting area, unless they need immediate attention and then will be placed in a bed and taken to the major ED.

None of this goes against EMTALA in that all patients will recieve a medical screening by a physician/PA while in the ED.

Quite a few hospitals use this method of patient self triage and I was hoping to get some input from those that do.

z's playa · May 11, 2005

I came in once w/ a migraine and begged to be fasttracked to the satellite unit. They would hear nothing of it. Even when I told them I wanted a shot of Imitrex only since it was pretty early on into it. They told me that they would need to put me in an ER room to get the iv and narcotics into me. I argued that I didn't want any but ......

10 hours later..after wating for a cube to be free...I was too far gone for imitrex and needed the darn narcs etc after all. A battle lost. Kind of ironic. :chuckle

I forgot my point......

Oh yeah..there is the potential for pts to actually minimize their complaints but few and far between. Everyone I'm sure thinks that by exagerating they'll get seen sooner. HA! :rotfl:

Maybe if a small note was written stating that the wait time may be shorter if they went to the fast track unit instead of through the whole shebang?

Z