TRIAGE

The penalty box! Triage can be pretty exhausting, what about at the 4 hour mark instead?

HPRN

We typically only triage for 4 hrs - because it can be a rough assignment. Fortunately there seems to be a lot of movement around this time - beds open up in the back etc.. When its really crazy - I just ask who is really sick? And who needs to go back next. No matter how busy it is - I scroll through any labs or rads that are back to make sure I don't have someone with a 35 wbc or a +fracture sitting in the lobby! Assuming care of 20 patients that you personally have not seen is scary. So even if it means patients waiting for triage while you get/give report - do it. We have techs that will continue to pull pts waiting for triage into the triage area, get ekgs and vitals while RNs are giving report.

Triage nurses, trauma bay, critical room, and procedures room switch out every 4 hours. Unless you want to stay after returning from breaks.

The 6-hour mark in the penalty box is indeed about where patience wears thin and sensory overload creeps in, so I'm glad to hear that your department is willing to try this.

Triage craziness certainly doesn't adhere to shift change flow, so does it really make a difference if assignments are switched at, say, 1pm vs. 3pm? Is it any less problematic to give report then?

I'm assuming it's a float/resource assignment and triage that are switching?

I wish our management would consider this. some nurses in my ED will be placed in triage for the whole 12 hours of their day... and for 4-7 shifts in a row!

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Yes we stay in for 12 hours. My

Place does not tend to utilize triage protocol orders like labs. Sometimes I order streps and urines

We stay for the full 12 too. We are seeing about 200+ patients per day lately and triaging over half of these people is downright exhausting some days. We usually have 2 triage nurses, 2 techs and one desk nurse that does a general screen on each pt that signs in. She is supposed to get up to help triage pts if we get backed up and there is at least a tech at the desk. We also have a triage / bed flow nurse which is the "hot seat" spot for the er. She answers all the EMS calls and places all the patients throughout the day based on acuity, etc.

We also have a quick track area in which 2 NPs screen patients and can order some basic labs and rads. After the pt is screened he or she is pulled to the back hall for blood draws. Of course, this can get backed up at times so they just sit back in the lobby to wait their turn. We also do urine pregs before rads too.

We recently started a direct care area in which low acuity patients are not placed on a bed at all. They sit in the lobby while all their test results are completed and then get called back to one of two rooms where they get their simple treatment (meds, shots, etc.) and then get DC'd. If the pt needs some simple sutures or an I&D, they go on a quick bed and get a quick release from there.

Sometimes I do wish we could split our triage days but there are some nurses that just aren't very good at triage and are slow at it. We also have some really good triage nurses that just prefer to do it than handle patient care all day. To each her own.

We stay for the full 12 too. We are seeing about 200+ patients per day lately and triaging over half of these people is downright exhausting some days. We usually have 2 triage nurses, 2 techs and one desk nurse that does a general screen on each pt that signs in. She is supposed to get up to help triage pts if we get backed up and there is at least a tech at the desk. We also have a triage / bed flow nurse which is the "hot seat" spot for the er. She answers all the EMS calls and places all the patients throughout the day based on acuity, etc.

We also have a quick track area in which 2 NPs screen patients and can order some basic labs and rads. After the pt is screened he or she is pulled to the back hall for blood draws. Of course, this can get backed up at times so they just sit back in the lobby to wait their turn. We also do urine pregs before rads too.

We recently started a direct care area in which low acuity patients are not placed on a bed at all. They sit in the lobby while all their test results are completed and then get called back to one of two rooms where they get their simple treatment (meds, shots, etc.) and then get DC'd. If the pt needs some simple sutures or an I&D, they go on a quick bed and get a quick release from there.

Sometimes I do wish we could split our triage days but there are some nurses that just aren't very good at triage and are slow at it. We also have some really good triage nurses that just prefer to do it than handle patient care all day. To each her own.

Just out of curiosity...do patients ever get upset at being moved around so much?

We also stay for the full 12. I agree, triage can be downright exhausting. I like the idea of switching out, though. Maybe I will suggest that to my director.

Just out of curiosity...do patients ever get upset at being moved around so much?

We also stay for the full 12. I agree, triage can be downright exhausting. I like the idea of switching out, though. Maybe I will suggest that to my director.

They don't seem to get upset. I agree that all that seems like a lot of moving around but it is faster than having them sit around and wait and wait til a bed becomes available. It is significantly lowered out LOS and our docs really like it too.

Thanks everyone. So no one has seen literature about effectiveness of the RN decreasing with longer shifts? We've had patient complaints increase for some of the nurses towards the end of the shift. Those are usually the nurses that hate triage to begin with. My preference is that the triage nurse have the option to switch out, but may stay on depending on how disruptive stopping to switch assignments is going to be. If we're busy things get missed during a hasty midshift report.