Triage Standing Orders for Lab and X-rays

[Rickbos]

We have a triage policy that allows the triage nurse to send certain complaint specific labs off out off triage and x-rays on obvious deformities. We do not have electronic order entry and the printed patient labels do not get generated for as much as 20-30 minutes after the patient has been triage and the spec/need for x-ray has been identified. Due to this there is a long delay getting these tests initiated.

The thought was to have the triage nurse keep collected lab spec and xray reqs in the triage room, wait for registration to complete the chart, get the labels, and send the specs/x-rays then.

The problem is, there is 1 nurse in triage and the nurse has no way to know when the ER registration/chart is completed, and is busy triaging other patients. Triage gets slowed down if the triage nurse is constantly trying to get labels from charts of patients they triaged 30 minutes prior.

Does anyone have any ideas how to expedite the process of these diagnostic tests or do we just let things bog down?

[classicdame, MSN, EdD]

Can you put a phlebotomist in the ER?

[Rickbos]

That would not be needed. I neglected to say that the labs we have standing orders for are strep screens, Urine for C&S, and UCG. We rarely send blood off from triage and that would involve a consult/order from the ER attending.

[Altra, BSN, RN]

How do things get done for critical patients whose labs can't wait? The 3 ERs where I have worked have all had a "quick reg" mechanism which gets the patient in the system and spits out an armband and a sheet of labels. Your IS dept. or software provider needs to make this happen. Alternatively, will your lab accept hand-written labels with the patient's name, DOB & MR number? I bet they would, as they would have to if there is ever unexpected computer down time.

[LoveMyBugs, BSN, CNA, RN]

How do things get done for critical patients whose labs can't wait? The 3 ERs where I have worked have all had a "quick reg" mechanism which gets the patient in the system and spits out an armband and a sheet of labels. Your IS dept. or software provider needs to make this happen. Alternatively, will your lab accept hand-written labels with the patient's name, DOB & MR number? I bet they would, as they would have to if there is ever unexpected computer down time.

:nmbrn:

Where I am at the pt reg can get them in and printed in 2-3min, what happens when you have a code with STAT labs?

[JStyles1]

All I can say is I'd hate to work there. I don't know what I'd do if I couldn't put in initial orders for patients (ie: cbc, cmp, ua, pcxr, etc). That is a major bottleneck for an ED. I guess your department must not be busy but in the department I work in we see 60,000+ patients a year and generally it is up to the discretion of the nurse to put in the initial orders for the patient due to the amount of patients we see. We have an initial protocol that has orders for just about every patient we see.

We keep a paramedic in triage with the nurse that will draw blood or start an iv on patients if it is necessary. The nurse will put the initial orders in the computer, the medic will get the blood then send it off.

[canoehead, BSN, RN]

If the triage nurse is able to write down the tests s/he wants in triage (on scrap paper if needed) then when the chart gets printed the secretary can place the scrap with the chart and order the indicated tests in the computer. If you need a permanent record of what the triage nurse requests use an outpatient lab slip to make the order.

[Rickbos]

Thanks for your ideas. Since I posted the original message I have worked it out our ER registration folks to register the patient in a timely manner to eliminate the problem I originally had. All is well for now...thanks