Triage-How is it done in your ER?

[crb613, BSN, RN]

I was just wondering how other ERs triage. We are having a little conflict at work.....so how does everyones triage process work? What determines which patient is seen first? I will fill in the details later....just want to see how it works in other places. Thanks!

[Altra, BSN, RN]

ESI triage, and occasionally gut instinct -- that's what determines who gets seen first.

[That Guy, BSN, RN, EMT-B]

ESI triage, and occasionally gut instinct -- that's what determines who gets seen first.

Ditto. We have a quick look nurse that assigns ESI and gets why they are here. Triage nurse then decides from ESI/wait time who gets it first.

[RNFiona]

One place where I work does forward triage...meaning the patients are sent right back to a room. Everyone hates it, the reason being..you will get slammed with 4 un-triaged pts at once, each one sicker than the next. Every time you try to take care of pts you already have you have to stop and triage a new one. So meanwhile the triage nurse is sitting out in the waiting room NOT triaging...all they do is a quick reg, if that..whilst the nurses inside are drowning and getting hit with ambulances at the same time. This is all done to to make the time from triage to room look good and to give the pts the illusion that they are being seen more quickly.But it's all BS. It's one thing if the triage nurse is slammed and it's not busy inside. Then I wouldn't mind. But that's not the case. I worked in a place where ONE nurse triaged all the walk-ins, AND walked them back AND gave a report. If you have a strong triage nurse this can be done very efficiently. And a strong nurse also knows when to ask for back-up. In some ER"s they have an ambulance triage nurse as well. It's largely helpful. Forward triage in my opinion should only be utilized if the pt is unstable or if the triage nurse is overwhlemed.

[emtb2rn, BSN, RN, EMT-B]

We have a triage nurse who does esi triage on walk-ins. Ekg & fsbs available in triage as well. We prefer to do ekgs at triage, unless esi 1 in which case we're heading immediately to a room. There's a triage tech as well who does the ekgs & takes pts to rooms.

The squad nurse does a quick esi assessment to determine placement for ambulance pts. This can include sending them to triage to sign-in.

[RNtoFNP42205]

We have one triage nurse that assigns an ESI. That being said I find a lot of nurses assign differently for the same complaint. As we are the top state hospital, we are often time full to the bone and you have to put some patient's back into the waiting room that you wish you did not have to. Where I worked prior to this hospital, we had the registration people call a triage now for chest pain, dyspnea, allergic reactions involving face/airway, strokes,etc (high acuity). Those patient's would be taken directly to a room and started treatment. I wish my current workplace did something more along these lines. I feel like the patient's are treated appropriately I just don't feel like we have the appropriate policies in place so that you don't get yelled at for bringing certain people back. I normally tell them that I am the one triaging and there is a reason I am concerned! I am curious as to what your issues are

[Salmo23,RN]

ESI, presentation and Acuity Level..... Gut instinct too, goes a long way too...

[emmy27]

Until recently, esi. Now we do straight back and triage in the room, and the triage nurse is not allowed to stay and help. So basically the triage nurse is a greeter until all the rooms are full. Then they can start triaging, but the mornings are chaotic now.

[MassED, BSN, RN]

without reading other posts first, what I do (and what I feel all should do) is to look at the lobby. Take a quick scan of everyone and see if their color's good, no one is in respiratory distress or falling out of a chair. Next look at their C/C. Airway complaints are always first (SOB, foreign body in airway, etc) Chest pain is always up there as a priority. Next would be any circulatory issues that are priority, such as vag bleeding or abdominal pain while pregnant. Scrotal pain (thinking torsion) is another priority. All others are then seen in the order they arrive. Of course each time I get a chart, I scan the waiting room. You have to always know that something can go on out there while you're triaging. Ordinarily I get a patient in and out in 2-3 minutes, so ideally every 3 minutes you're scanning that lobby. We use ESI in 5 stages.

[MassED, BSN, RN]

We have one triage nurse that assigns an ESI. That being said I find a lot of nurses assign differently for the same complaint. As we are the top state hospital, we are often time full to the bone and you have to put some patient's back into the waiting room that you wish you did not have to. Where I worked prior to this hospital, we had the registration people call a triage now for chest pain, dyspnea, allergic reactions involving face/airway, strokes,etc (high acuity). Those patient's would be taken directly to a room and started treatment. I wish my current workplace did something more along these lines. I feel like the patient's are treated appropriately I just don't feel like we have the appropriate policies in place so that you don't get yelled at for bringing certain people back. I normally tell them that I am the one triaging and there is a reason I am concerned! I am curious as to what your issues are

highlighted above: we do this too, but the large problem with this (and where I've worked in the past registration never has done this) is that you are trusting registration to create a complaint and not having any medical training. They are simply being told what's wrong with them at the time of check in. They don't have the training to look at a patient and know that something is wrong, whether it be rate of breathing, skin color, uneven pupils, sweating, etc.

[TraumaNurs]

I know the procedure for Triage, but I have a question. Do any of you do minor assessments in Triage? For example, someone has a laceration. Do you measure the size, severity of the lac in the triage room?

[jallen326]

I know the procedure for Triage but I have a question. Do any of you do minor assessments in Triage? For example, someone has a laceration. Do you measure the size, severity of the lac in the triage room?[/quote']

I am not going to sit there with a ruler but you can estimate it and determine the severity on triage. If we r swamped and the minor care area had no patients then they will go straight to the room for triage.