Triage

LilgirlRN, ADN, RN · Jan 19, 2011

I used to be the RN that routinely did triage. I have 20 years plus in the ER, easy for me to say who goes where, right? Then we got a new doctor group. They're emphasis is on speed. To me this is stupid, we're going to miss something and someone's gonna croak.

This is how we are now doing triage. Tech sits out front. See the patients coming in. Patients are asked to fill out a mini reg form that says their name and whats wrong with them. At the front desk with the tech is security. The patient hands their reg form to the security officer who shows it to the tech and then hands it off to registration. The triage office is right beside the front desk. Do I triage in the triage office? NO. Does the tech stop and get vitals before she determines where the patient ought to go? NO. She has to decide on her own with just a complaint if the patient needs a trauma room, a regular room of if they can go to fast track. She puts the patient in the room and then calls me to triage them in the room. Most of our techs are at least basic EMT but still sometimes they get it all wrong.

I cannot imagine asking one of our secretaries to decide where a patient should go let alone rate their acuity. You're not alone, everyone is trying to save a buck wherever they can. You've been given a responsibility that you aren't capable of performing. I say let secretaries do what they do best and allow nurses to do what they do best. Your boss needs a kick in the butt.

emtb2rn, BSN, RN, EMT-B · Jan 19, 2011

We use the setup described by Altra. Works pretty well, we prefer to get the ekg, vitals & weight before sending the ESI level 2's back. Our docs & mgmt have no problem with us calling the code mi from the triage ekg room (hey, you just jumped to a 1). And obvious ESI level 1's go straight to a room.

We can see the pt's talking to the reg clerk which gives us a feel for the sense of urgency. The clerks collect information, that's it.

Golfenaround · Jan 22, 2011

When a pt. first comes to our ER from outside, they take a number. They are first seen by a RN. Once we triage them (EPOD) computerized chart, it prints off and the admitting clerk who are right beside us, process the outpt. form. Any triage code 3,4,5 (we leave in our waiting room) until a spot is available. Our CTAS 1 (usually are VSA's) come in by ambulance. Our CTAS 2 (they are usually brought in quickly (cardiac, asthmatics) etc... On occasion we have brought in CTAS 2 CP non-cardiac features, quick ECG, show MD and send them back to the waiting room. RN's are doing this not the clerks. Our triage is 24/7 by RN. Waiting room seen at all times from desk. Our clerks will interrupt us and advise if someone is in the waiting room with CP. I have had this happen and I quickly do a check over the pt. and have sometimes bypassed the one I was triaging due to history and so forth. Experience, clinical judgement are important.

It sounds to me that your employer is practising poor risk management.

whyspir · Jan 23, 2011

i quite agree. any form of assessment, basic or not, is outside your job description. some states do not allow LPN's to assess. their "assessment" has to be signed off by an RN. you are putting yourself into a bad legal situation by doing that. I'd speak to your director. At my ER, registration sits out front and if there is not a nurse out front (due to heavy patient volume) they call back and tell us there is a patient out front. the nurse must still come assess and triage.