triage suggestions

[nurse ninja]

the ED i currently work in has been utilzing a triage system where the pt completes a half sheet by filling in chief complaint and basic demographic information. after completing the half sheet the patient provides it to the triage nurse. the patient is triaged as soon as possible and asked to register if they do not need to go directly back. after registration pt waits in lobby until room is available. pts are reassessed as needed.

we are working with bluejay consulting to improve tirage times, ect... they have implemented a system where one triage nurse is responsible for watching the lobby to identify new patients. we are then suppose to approach the patient ask them their cheif complaint and decide if they neeed to be triaged next. when we are busy we are to ask who is next ect... and then determine who needs to be triaged.

i have worked in ED's where we kept the lobby closed and did something very similiar to this, but we still did half sheets. when rooms are not available we did a full triage and put pt in lobby.

what i am looking for is any input how your ed does triage. what is the pt flow from the time they enter the lobby until they get back to a room.

[EmergencyNrse]

I'm no fan of the ENA but here it is....

Triage First

[nedlloyd]

where i work the process is for patients to register first at the main desk. the staff at the front desk write the time and reason for visit in the computer (3-4 word description) along with basic info such as name/age etc. the form is printed out and dropped through a slot into the triage room next door. nurse triages and patients are brought into the ED right after, whether into a bed or the 'fast track' waiting area. triage done in order of priority obviously, except in cases where presenting complaints are similar, and then the patient who arrived first is seen first.

if someone comes in with an emergency the process is skipped, pt brought straight into ED and paperwork done later.

waiting times are hard to say obviously. if the lobby is getting really crowded and there is a tech available we send them out to take vitals.

[nurse ninja]

thanks for reply, that is very similar to how we use to do it and how i have experienced it being done in other ED's.

[pharmgirl]

We have our 1/2 sheets at the triage window. The patient fills out the sheet and gives to the triage nurse, the nurse then writes their name/dob/complaint/time in "the book". The 1/2 sheet then gets passed through to registration. Once registration is done, we call the patient back and do a full triage assessment including vs. At that point, if there is a room available we take the pt back and report to nurse and ermd. If there is no room available, the patient is returned to the lobby and their chart placed in the rack. The charts in the rack are arranged by priority. As nurses in the back discharge patients, they are able to come get a new chart as they are ready.

We triage within 5 minutes of the patient walking in the door. (of course, there are those times when the bus stops out front and 10 people show up at the same time). If we are busy sometimes people can wait 2 hours to be brought back to a room, sometimes they are in and out in an hour. Luck of the draw.

[crb613, BSN, RN]

Ours goes like this....Pt comes in signs name/dob/time.

Triage nurse is at front window & eyeballs each pt.

Pt are triaged in the order they sign in...unless true emergency.

Pts are assigned to main ER or fastrack. Name C/O appears on tracker board.

They now go to registration & registration takes them to assigned room when process complete.

All wait times depend on C/O & volume.

[Christy1019, ASN, RN]

where i work the process is for patients to register first at the main desk. the staff at the front desk write the time and reason for visit in the computer (3-4 word description) along with basic info such as name/age etc. the form is printed out and dropped through a slot into the triage room next door. nurse triages and patients are brought into the ED right after, whether into a bed or the 'fast track' waiting area. triage done in order of priority obviously, except in cases where presenting complaints are similar, and then the patient who arrived first is seen first.

if someone comes in with an emergency the process is skipped, pt brought straight into ED and paperwork done later.

waiting times are hard to say obviously. if the lobby is getting really crowded and there is a tech available we send them out to take vitals.

just curious... is the person at the front desk registering the pts a nurse or a registration person? The only reason i ask is that I was recently discussing different triage ideas with one of our staff MDs and suggested something similar and she told me it was an emtala violation for a pt to be asked to register/provide proof of funds before seeing medical personnel.

[nurse ninja]

it is indeed an emtala violation to ask for proof of payment, insurance, ect... prior to a medical screening exam

[Altra, BSN, RN]

just curious... is the person at the front desk registering the pts a nurse or a registration person? The only reason i ask is that I was recently discussing different triage ideas with one of our staff MDs and suggested something similar and she told me it was an emtala violation for a pt to be asked to register/provide proof of funds before seeing medical personnel.

it is indeed an emtala violation to ask for proof of payment, insurance, ect... prior to a medical screening exam

That's not quite correct.

What is an EMTALA violation is to delay a medical screening exam in order to ask about insurance, payment, etc. If the patient has a non-emergent chief complaint, all beds are full, and the patient is waiting for a period of time in the waiting room anyway ... there is no reason not to complete the registration process including asking about payment status while they are waiting.

Remember too, triage is not the MSE, unless the hospital specifically has a policy in place that says that triage is the MSE. These are typically set-ups that include a mid-level provider or a physician in triage.

[mmutk, BSN, RN, EMT-I]

We do not address payment issues until after the triage and a MSE in our ER. In fact we are so used to seeing indigent patients that really we just asume no one has insurance anyways.

Our triage is done by a patient checking in the lobby with registration. They log them into the compter and thier name and chief complaint is visible on the tracking board. The triage nurses can also visually see the waiting room and check in.

High risk complaints (e.g. Chest pain, SOB, Gunshot wound) are seen first and then we work our way down by severity of complaint as to who we triage next.

On a side note BlueJay consulting is a great service and I highly respect many of the staff of that company as I have worked with several of them when they were nurses on the front lines.