Triage Vital Signs

amandab13 · May 6

ER in Alberta Canada.

32 beds and 10 chairs.
People wait...a long time. Depending where they're going in the department, but 6-8 hours in the waiting room is normal.
We have a dedicated nurse to reassess the waiting room and vs are repeated every two hours at the minimum. That nurse is to notify the triage nurse if the patients condition has changed.

FiremedicMike, BSN, RN, EMT-P · May 16

30 bed ED with 10 bed fast track for soft 3s, 4s and 5s.

Patient waits vary depending on volume at a given moment, but it can reach several hours some days.

The honest truth is that 3-5s probably aren't getting their vitals rechecked, especially if WNL on triage.

1s go straight back, 2s don't generally wait too long, but when they do one of the triage staff will reassess as directed by the triage RN.

Edited to add, we have an APP assigned to triage and will see the patient as a part of the initial triage process, if that helps.

Amanda Houtz · May 29

Free Standing ER

2 Vertical Care (fast track) beds, aka VC

11 monitored beds

1 hall stretcher with a monitor but not connected to central monitoring.

We can surge up to 3 more hall chairs.

Typical wait time of less than 90 mins. If more than 2 hours. Charge or VC nurse will redo vitals if triage nurse still busy.

lcb · Jun 13

I work at a big level 1 trauma ER in the heart of downtown of a major city.

We're the only public safety net hospital in our city, and we see a huge volume of very high acuity patients. (We're probably in the top 5 busiest ERs in the country.)

We have 15 fast track beds, around 60 (give or take, there's always room to squeeze in one more somewhere in the hallway!) acute medical ER beds, and 30 trauma beds with 7 bays. We also have 2 observation/inpatient boarding units of, IDK, 30 or so beds each? plus a detention unit and a psych unit, so between 200-300 patients total in the ER at any given time. We also offer scheduled outpatient dialysis in our ER so there are always people in the waiting room for that on weekdays. I don't think I've ever seen a volume lower than 100 patients total in the entire ER department.

Our waiting room wait is, obviously, LONG. Can be as short as 4 hours, as long as 12. Average is probably 6-10?

All 1s and 2s go straight back, they don't wait at all. 4s and 5s get moved through the fast track pretty quickly, and sometimes get discharged straight from the WR. 3s wait forever.

On an ideal, perfectly staffed day, the waiting room has 5 nurses: 3 triage nurses, a charge, and a "nurse first" RN sitting at the door to catch any critical walk-ins and manage the chaos of the waiting room. Ideally there's also a patient care tech, possibly 2. There's also an EKG tech and a phlebotomist who does labs for both WR and fast track. The patient care techs mostly do triage vitals, but if there are two (that never happens though), then one will do repeat WR vitals, along with the nurse first. We are supposed to get vitals for all WR patients q. 4 hours. That rarely happens. However, it's rarely more than 15 mins to get those initial triage vitals, and if the vitals are unstable, the patient gets called back as a 2 and wheelchaired back to a bed to get seen immediately.

There's also an APP who assesses patients before they get to triage. When they first come in, the nurse first does an across-the-room assessment, then if they look stable at a glance they go to registration and then to the APP for a quick initial assessment of their chief complaint. If they have chest pain, the APP sends them straight to EKG. Stable patients wait 10-15 minutes before they're called up for triage and initial vitals. They then get sent to phlebotomy for initial labs.

We have a separate triage area for ambulance arrivals, which usually has 2 nurses, registration, and a provider. The ambulance triage area also has a traffic control nurse, who keeps track of where all the ESI 1s and 2s are going (we have multiple zones and multiple stabilization bays). Nobody is supposed to wait in ambulance triage, though; if they're stable to wait, the ambulance crew takes them to the waiting room.

Reassessment of patients in the WR after triage is done three ways:
* The tech is supposed to get vitals q. 4 hours, but like I said that is rare...probably every 5-6 hours is more average but they do get retaken. If they're changed/unstable, the tech is supposed to tell the charge nurse. Sometimes nurse first is the person doing those.
* The nurse first and the charge nurse both keep an eye on the whole WR and watch for anything weird/concerning (mostly signs of an impending fight breaking out, but also something like someone falling off their chair or whatever).
* The APP keeps an eye on lab results for patients in the waiting room. If something comes back super wonky (only life-threatening wonky, like an elevated K+ for someone who isn't a dialysis patient), they get uptriaged to a 2 and called back for an immediate bed.

Obviously with the level of acuity and volume we have, we need to do a ton of monitoring in the WR and even with all that, we still have pretty bad *** happen in the WR. We are usually pretty decent about catching medical emergencies in WR patients, though. Usually the WR events are stuff like fights breaking out, or fires in the bathroom cuz someone was smoking in there. Those kinds of things happen regularly, LOL.