Triage in rural hospitals

[1nuttynurse]

I work in a small rural hospital, we see about 60 pt's a day, with 1 Doc, and 3 Nurses, and 9 beds. Our triage system is, a pager rings when a pt is in triage and 1 of the 3 nurses is supposed to go out and triage the pt. When we are busy, triage is missed. This system is failing miserably and I was wondering what other small hospitals are doing? Any suggestions? Thanks.

[mom2michael, MSN, RN, NP]

I'm an ER tech in a small hospital (working on the RN thing now) and what we do is once the patient comes in, admission starts the basic questions (who are you, what is wrong, etc...) they then call our desk in the back. The RN/LPN has 5 mins. to triage the patient and sign that they have done so (we have a log on our desk, admissions has a log at their desk). If for some reason it's 7-10 mins, it's really no big deal, but if it passes 10 mins. then admissions calls again to remind the nurse (or whoever answers the phone) that a triage needs to be done. There are obvious clinical complaints that do not require triage at all and we just bring the patient straight back.

It's really not a great system, but for the most part it works. As the tech, it's usually my job to remind the RN/LPN 20 times that we have a triage. From 11-11 we have an additional RN/LPN who is there primarly to triage, so that helps out too. Most people leave after triage because that wait is less than 5 mins. but the wait to get in after triage can be 2+ hours if we are busy.

[lifsavER67]

I also work in a small ER. We are a 72 bed hospital, 11 bed ER. We currently see about 60-70 pts. each 24 hours. However, staffing has not changed in the 11 years I've been there, while the pt load has doubled. We are staffed with 3 RN's, an 11-11 LPN and a Dr.. On weekends we have a PA.

1 of the RN's is the triage nurse, this duty is rotated each shift. When triage is not packed the person triaging helps out in the back or triages pts to chairs that are non-urgent and they and the PA take care of these people. This sometimes helps with the flow thru ER. Otherwise, the triage person is out there constantly except for when they bring a pt back. She also prints out an extra triage form and gives it to the nurse whose room it is. That nurse then knows they have a new pt and goes and does their assessment.

The 2 nurses in the back each have 5 beds, 6 beds each with an LPN that helps with orders, reassements, etc. We also just in the past few days have gotten a CNA for weekends. She keeps beds changed, helps with vitals at triage, brings pts back from triage, whatever.

We also are very lucky to have an excellent House Supervisor to call on when needed.