Triage at the bedside

Specialties Emergency

Published

We have been practicing triage at the bedside with the theory that the pateint is safer with the nurse than in the waiting room. The nurses have revolted and truthfully feel that this compromises not only patient safety but their licenses as the patient is placed in the room with unknown acuity and left until someone comes into triage. Our current system allows a triage float nurse and a dispo nurse; however if the system gets bogged down, too many ambulances come or a bunch of people arrive at the same time. Everyone is compromised!

We are looking for alternative solutions for presentation to our new director. I believe we need a plan B as no business would run with just one way of doing business.

PLEASE HELP! We can't take it anymore! There has to be evidenced base practice that will support not doing this crazy practice unless there is sufficient staff!

Thanks

We are now talking about bedside registration to see if it will work for us. I have read the posts from the past year and understand that communication is key. What about actual numbers of staff to man the ED and staff it for the very busy days. I would like to compare our staffing to other hospitals to see if we are staffed to make this work.

What numbers of nurses are you using out there? During what hours? how many staff at triage? RN, tech aide, registration? Do you habve a dedicated doc for triage or one who can at least come to triage to start orders? Do you have standing protocols?

How many for fast track ? What hours? RN's, aides, NP, PA or MD?

How many yearly visits or daily visits average?

How many beds in ED? Fast track?

i will be very interested to know.

Specializes in ED only.

We are now talking about bedside registration to see if it will work for us. I have read the posts from the past year and understand that communication is key. What about actual numbers of staff to man the ED and staff it for the very busy days. I would like to compare our staffing to other hospitals to see if we are staffed to make this work.

What numbers of nurses are you using out there? During what hours? how many staff at triage? RN, tech aide, registration? Do you habve a dedicated doc for triage or one who can at least come to triage to start orders? Do you have standing protocols?

How many for fast track ? What hours? RN's, aides, NP, PA or MD?

How many yearly visits or daily visits average?

How many beds in ED? Fast track?

i will be very interested to know.

TO SENIORWVNURSE;

28,000 patients per year, 14 ER beds, 2 RN's in back (bed area) 7a - 12 then 3rd nurse comes in 12-12 - 3 RN's total until midnight, 2 nurses come in at 7p - 7a. HUC (secretary) all 3 shifts, paramedic on-staff all 3 shifts - does most of IV's, IV meds. Triage nurse 8 am until 8 pm. Urgent care 5 pm to 11 pm weekdays, 12-11 weekends, own PA and medical assistant - we do not help them unless they are drowning - then we lend a hand when able, they are off a wing of our ER (5 rooms) (we use these rooms during the day when we are busy but must have them vacated by 5 pm). One ER physician, has nothing to do with triage. One PA comes in at 10 AM and another at 12 pm - so 3 providers in the ER - they work 12 hour shifts - doc and PA's. We have one tech in back 12 noon to 12 midnoc. Out front in waiting room - 2 ER techs - they do registration (name, birthdate, primary complaint and consent for treatment form signed) - take pt into triage room, get vitals, triage nurse takes over in triage room. Then, when ER techs at front desk are free, go back to patient rooms and do complete bedside info-address, phone numbers, copies of insurance cards.

Standing orders for pain/nausea control. IV starts ordered by triage nurse, anti-nausea medication and pain medication can be given before physician/PA even sees the patient. Triage nurse orders appropriate labs and these are often drawn before doc gets in there - also from standing orders for "adult abdominal pain" or "adult chest pain", etc. Docs have approved all the standing orders so that nurses can get whole process started sooner rather than later.

We do bedside triage if there are many empty beds and no wait to see triage. They also spread out where the patients go so that you're not given a full load all at once. Our ED also has a 5-1 ratio for lower acuities and 4-1 or 3-1 for higher acuities.

There's usually a float nurse and when staffing is low for our patient load our manager and nurse educator take patients to help out. Everyone also watches the board- if things are slow for you and someone else has a lot of unexecuted orders most people are good about offering help.

I think if I got dumped with 4 mystery patients at once I'd hate that too- has your hospital's policy changed since you started this thread?

We have had no policy change and are talking about this now. We are going to trial the process by starting just the bedside triage and registration by the RN of ambulance patients for now. It is not too different from what we are already doing. We will see how that process goes before we start open bed triage.

I worry about the patient who may be placed in a bed when the nurse may easily be getting 4 or more new patients and not get to assess them timely.

Specializes in Emergency & Trauma/Adult ICU.

It doesn't require a policy to avoid loading one nurse with 4 new patients in a row - just communication and common sense.

I'm not totally opposed to bypassing triage if the department is pretty empty and the patient appears in no distress. Although we've all had patients "in no apparent distress" who turn out to have stroke-level BPs or unstable dysrhythmias or other bad ju ju happening.

In my experience, immediate bedding can work (at those glorious times when there are actually empty beds!) IF there are certain underlying factors:

Nurses are assigned to a block of contiguous rooms.

A physical departmental layout conducive to good sight lines to all rooms.

Division of assignments between emergent and non-emergent.

An understanding that you don't fill up your emergent rooms with non-emergent patients.

No charge nurse/MD manipulation of the tracking board -- e.g., marking rooms as "empty" just because the MD has physically produced discharge instructions, without taking into consideration that there are splints/crutches/wound care/take home meds/delays getting the patient dressed/time needed to explain discharge instructions/etc./etc./etc. Yes, it might take another 20 minutes to actually get the patient out of the room, and the nurse is not a slacker for doing so, and no, another patient may not be taken back to that room just yet ...

Thanks for the reply. We are experiencing patient surges that do not correspond to the available nurses. we have tracked our patterns of patient visits and tried to adjust our staffing patterns but very often we are just overwhelmed. I think it is a manpower issue. We are all working as hard as we can. That is why I am so interested in staffing ratios.

Specializes in ER.

At my hospital, we have "team triage". There are 3-4 RN's doing triage in little triage rooms. Based on acuity, and pt's appearance/behavior they are either sent back out to the waiting room (wr) or placed in the internal wr to wait for a room assignment. the internal wr is really just a hallway with recliners within view of the triage nurses. those ppl are upgraded in priority to get a room sooner.....the ppl in the wr are assigned by time in department. the only time we triage in the room is when they come via ems. It does get busy and sometimes, you have to ask someone to triage your ambulance pt for you if you're tied up in another room. We usually get a call from the flow coordinator to let us know we have a pt coming....it helps you manage ur time a little better.

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