triage question

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i was recently criticized at work for how i triaged a pt. i was wondering how anyone out there may have triaged this pt:

a patient presented to us with a chief complaint of a boil in the left groin region for 3 days. pt stated a hx of these and that they normally drained on their own after 2 days. pt stated this one had not started to drain yet and was becoming painful. pt was requesting to have it lanced. pt VS were stable as listed: HR 86 T99.8 R20 BP 120/80, pain 7/10. pt did not appear to be in distress.

What ESI rating would anyone else have given this pt? any input would be helpful.

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Specializes in ER/ICU/STICU.

From the details you provided I personally would have given him a 4. It sounds like he needs it to be drained and given some PO pain meds and abx.

As far as someone questioning your triage and I would simply state your rationale and your assessment of the patient. No one is going to be right 100% of the time with the triage ESI level because what you think the patient is going to need and what the MD thinks the patient needs can be very different. We have all seen people in fast track get admitted and vice versa.

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Specializes in Emergency.

Agree with ESI 4, fast track all the way. If it turned out to be more complicated and an admit, no biggie. Happens.

What did the person who criticized you think the level should have been?

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I bet they thought it was a 2 because of the "severe pain or distress" part of the equation.

I would have used a 4.

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Specializes in Emergency & Trauma/Adult ICU.

Let me guess: the provider who saw the patient decided he needed blood cx and IV abx ... and this cause someone to flip out. And/or ... he required IV pain meds or possibly even conscious sedation for the I & D.

:rolleyes:

It happens.

I would have made this patient a 4 as well.

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Specializes in Emergency Medicine.

Without having seen the patient I would agree with the 4.

Back of my mind is the low-grade fever but without knowing

if he/she were diabetic and other risk factors I might consider

to bump up to a 3. But 2??? Someone is padding the books...

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Specializes in ER, ICU.

I agree with the 4. Even if they needed antibiotics and blood cultures this could still be done in fast track.

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Specializes in ER, Trauma.

Agree with all the above. 4 was appropriate. Triage is a quick look to make sure the sickest get seen first. From the quick look, you did right. Nobody can predict the future accurately, nor the differant ways Dr's treat patients. I think of the jovial patient who came in with a broken thumb. An hour later he's in X-ray and has a big M.I! Survived, but the boss tried to rag on me for triaging him the way I did. Geesh!!

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Don't you love hindsight triagers?

We'd all be 100% accurate if we knew the outcome at the time of triage.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
An hour later he's in X-ray and has a big M.I! Survived, but the boss tried to rag on me for triaging him the way I did. Geesh!!

LOL .... note to self: get crystal ball fixed... ;)

To the OP: 4, with room for a 3 if other factors present themselves. You did nothing wrong.

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Specializes in ER, Trauma.
Don't you love hindsight triagers?

We'd all be 100% accurate if we knew the outcome at the time of triage.

Amen, sister.

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thank you all for all the input. it makes me feel better. i did triage this pt as a level 4. turns out he had forniers gangrene and the provider tried to send this pt home. that was the issue we were pushing with the one's criticizing us. so far nothing is being done about the provider who was refusing to keep the pt after he started to go downhill. me and one other nurse were the only one's trying to push for this pt to stay or be transferred to a better equiped facility when 3 hours after i triaged him he spiked a fever of >102, went tachycardic and bp started to drop. the patient looked awful at that time. a complete 180 in comparison to when i originally saw him. if any of us had had experience seeing fornier's gangrene we may have triaged differently, but considering he looked good and every thing was originally stable we still probably would've given him a 4. if only every one who does triage could be psychic, how much easier it would be. but thank you all for you're comments on this. i had to go to a peer review which was full of head of other departments and only one nurse who hadn't even had any triage experience or done pt care in years and they were telling me i did my job wrong and that was way the pt went bad so fast. had me really questioning myself. so thank you all for your opinions, it really does make me feel better.

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