Our ER is trying to revise our triage template (computer charting) to remove any questions that are not needed at triage. Not saying we won't ask them EVENTUALLY, once the patient gets back into a room, but to avoid the backup that we've had, where people may sit out in the lobby for an hour before anyone ever speaks to them, we're trying to find ways to triage faster.
We've had nurses say certain questions MUST BE ASKED during the triage process, as per JCAHO (I think...and maybe EMTALA??). We're screening for suicide & abuse, of course, TB, fall risk, alcohol use, drug use, smoking. All that along with an assessment.
So what REALLY HAS to be done at triage, and what can wait until the patient gets a bed?
I really think the problem is that the new nurses (who shouldn't be in triage in the first place, but that's another story, staffing is stretched to the limit right now) can't do a quick focused assessment. Their triage takes way too long, and we get backed up. NOT because of the previously mentioned questions, but because they're assessing every little thing rather than doing a focused assessment. Obviously quicker assessments will come in time for all of them.
But for now, what exactly are REQUIRED triage screening questions, and what can wait until the person gets a room?
Can anyone give me a sample of exactly what is asked in your ER? Our assessment screen even has things like "behavior" and "appearance". That's appropriate if the person is suicidal or homicidal and the behavoir is "agitated" or "combative" or whatever, but 99% of the time, nurses will write "apearance is uncomfortable" (yeah, duh, they have abdominal pain of course they're uncomfortable) and "behavior is cooperative" (that doesn't help me, where as agitated or combative might). Same with respiratory...most nurses think it's crucial to chart ALL the Resp. fields "breathing is even & unlabored, airway is patent, breath sounds are clear bilaterally" while others are happy with "no deficits noted". We have LOTS of that, where some nurses are fine iwth "no deficits" and move on, while others insist upon charting "abdomen is soft & non-tender in 4 quadrants, bowels sounds present in 4 quadrants, denies n/v/d" even when the chief complaint has nothing to do with GI! And cardiac is another one that most people feel is crucial to at least chart "denies chest pain, denies SOB", they won't just chart "no deficits", and they won't skip the field altogether. Dermatologic "skin is intact, warm, normal color and dry" rather than "no deficits" or skipping that field altogether. We are "supposed" to be charting by exception but they feel they need to "CYA" by charting all of it...hence triage is taking a few minutes longer for each patient, which isn't a big deal until you get 15 people behind that haven't been triaged.
So what are our legal (or EMTALA or JCAHO) requirements on charting and screening in triage? And what are our liability risks for "no deficits" or not charting something at all? I've never been involved in a court case where my charting came up so I honestly don't know how to help the triage committee pare down the process within legal and liability constraints, and we have nurses who simply refuse to triage any way other than the way they've always done it, which is a complete and full assessment (with NEVER a "no deficits noted" comment)! Maybe they're being smart and I'm naive, and if so, I need to know that!
Any help would be appreciated as we try to streamline our process.
